Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses.

Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.

Predictive Value of Diaphragm and Lung Ultrasonography for Weaning Failure in Critically Ill Patients with Acute Respiratory Failure Due to COVID-19 Pneumonia.

BACKGROUND: This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices-maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns-with weaning failure. METHODS: This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. RESULTS: Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01-1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86-0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98-1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. CONCLUSIONS: Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study.

Exploring consistency between stated and revealed preferences for the plastic bag ban policy in Chile.

This paper exploits individual-level data before the implementation of a national policy to understand the factors driving avoidance of plastic consumption and explore potential inconsistencies between revealed and stated preferences for a plastic bag ban policy. We estimate a bivariate ordered probit model that allows us to account for a potential correlation between these types of preferences. The data reveals that while 71% of respondents take a reusable bag for shopping, only 58% of the sample state to strongly agree with prohibiting plastic bags. We find that gender, age, environmental concerns, environmental efforts, participation in environmental causes and pro-environmental behavior determine avoidance of plastic consumption, but no effects are found for being in favor of the prohibition. We also find inconsistencies decrease for individuals demonstrating higher pro-environmental behavior in related domains. This indicates waste management policies may benefit from local grounded knowledge from related environmental initiatives.

Aspectos fisiopatológicos de la rehabilitación respiratoria en fibrosis quística / Pathophysiology of respiratory rehabilitation in cystic fibrosis

The Cystic Fibrosis (CF) is an autosomal recessive disease and is triggered by a mutation of the gene coding for cystic fibrosis transmembrane conductance regulator (CFTR) protein; being the respiratory, cardiovascular and musculoskeletal system affected for this mutation, the systemic consequences of CF produce altered physical performance, expressed in less VO2 peak levels which is directly correlated with CF survival rate. In this context, the pulmonary rehabilitation (PR), through aerobic exercise, anaerobic exercise, respiratory muscle training, has shown to be secure and effective in reversing functional decline caused by CFTR mutation. In this paper we review the most important aspects related to exercise pathophysiology and the impact of training on physiological and clinical variables in patients with CF, in order to provide a comprehensive view about of the benefit that the physical exercise could generate in the CF course.

La Fibrosis Quística (FQ) es una enfermedad autosómica recesiva y se produce por una mutación del gen que codifica para la proteína reguladora de la conductancia transmembrana (CFTR); siendo el sistema respiratorio, cardiovascular y músculo esquelético afectados por esta mutación. La repercusión multisistémica de la enfermedad, causa alteración en el rendimiento físico, expresado en caídas en el VO2 peak; el que está directamente correlacionado con la sobrevida del paciente portador de FQ. En este contexto la rehabilitación respiratoria (RR), a través del ejercicio aeróbico, anaeróbico, entrenamiento muscular respiratorio y general; ha demostrado ser métodos seguros y efectivos, en la reversión del deterioro funcional causado por la mutación de la CFTR. En la presente trabajo se hace una revisión de la literatura sobre los aspectos más importantes vinculados a la fisiopatología del ejercicio, y el impacto del entrenamiento sobre variables fisiológicas y clínicas en pacientes con FQ, con el fin de proporcionar una mirada integral acerca de los beneficios que potencialmente puede generar el ejercicio en el curso de esta enfermedad.