<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8909</journal-id>
<journal-title><![CDATA[Medicina crítica (Colegio Mexicano de Medicina Crítica)]]></journal-title>
<abbrev-journal-title><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></abbrev-journal-title>
<issn>2448-8909</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Medicina Crítica A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-89092023000700600</article-id>
<article-id pub-id-type="doi">10.35366/114862</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Fracción de engrosamiento de músculos paraesternales intercostales y engrosamiento diafragmático como predictores de fracaso de la prueba de ventilación espontánea]]></article-title>
<article-title xml:lang="en"><![CDATA[Diaphragmatic shortening fraction and parasternal intercostal shortening fraction as predictors of a successful or failed spontaneous breathing trial]]></article-title>
<article-title xml:lang="pt"><![CDATA[Fração de espessamento de músculos paraesternales intercostais e espessamento diafragmático como preditores de falha no teste de ventilação espontânea]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Reyes Vidal]]></surname>
<given-names><![CDATA[Alejandra Estefanía]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[López Márquez]]></surname>
<given-names><![CDATA[Santa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vidal Andrade]]></surname>
<given-names><![CDATA[Erick Rolando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cerón Díaz]]></surname>
<given-names><![CDATA[Ulises W]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Español  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2023</year>
</pub-date>
<volume>37</volume>
<numero>7</numero>
<fpage>600</fpage>
<lpage>604</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092023000700600&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092023000700600&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092023000700600&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  en los pacientes críticos con falla respiratoria que requieren ventilación mecánica se ha descrito el daño muscular diafragmático que condiciona fracaso de la desconexión del ventilador. Durante la ventilación mecánica se ejerce un efecto de reclutamiento de la musculatura accesoria. El ultrasonido es un método de bajo costo y fácilmente reproducible, que se puede utilizar para evaluar la actividad del diafragma y la musculatura accesoria para predecir el riesgo de fracaso de la desconexión de la ventilación.  Objetivo:  determinar el valor predictivo de la fracción de engrosamiento diafragmático (Tfdi) y paraesternal intercostal (Tfic) para el fracaso o éxito de la prueba de ventilación espontánea (PVE).  Material y métodos:  estudio transversal, observacional, prospectivo en pacientes mayores de 18 años bajo ventilación mecánica invasiva en quienes se realizó PVE y se realizó la medición de fracción de Tfdi y Tfic mediante ultrasonografía.  Resultados:  se reclutaron 32 pacientes, con PVE exitosa en 93.7%, la mediana de horas de ventilación mecánica fue de 90.5 horas (IQR 40.7-164.2). Se encontró una mediana de Tfic de 7.54% (IQR 3.8-9.3). La mediana de Tfdi fue de 32.7% (IQR 24.1-40.9). La correlación entre la Tfdi y la Tfic fue nula (r = 0.076). Se identificaron cuatro grupos de pacientes con distintos patrones de engrosamiento intercostal y diafragmático. Se encontró una correlación negativa entre la fracción de engrosamiento diafragmático y el índice de masa corporal (r = 0.32), y una correlación positiva baja entre horas de ventilación mecánica y la fracción de engrosamiento intercostal (r = 0.28). No se encontró diferencia estadísticamente significativa entre los pacientes con PVE exitosa y fallida, tanto para la Tfdi (p = 0.52) como para la Tfic (p = 0.79).  Conclusiones:  no podemos concluir respecto a la capacidad predictiva de éxito en la PVE del engrosamiento intercostal y diafragmático por la escasa cantidad de pacientes que fracasaron en la PVE. El análisis de la correlación entre fracciones de engrosamiento, sugiere cuatro grupos de pacientes, en los que ambas fracciones de engrosamiento identifican patrones distintos de reserva muscular respiratoria.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  diaphragmatic muscle injury has been described in critically ill patients who require mechanical ventilation, as well as its effect on weaning failure. During this period of diaphragmatic dysfunction there is a recruitment effect on accessory muscles. Ultrasound is a low cost diagnostic tool, easily reproducible and can be used to assess diaphragmatic and accessory activity.  Objective:  determine the predictive value of the diaphragmatic (Tfdi) and intercostal thickening fraction (Tfic) for the failure or success of the spontaneous breathing trial (SBT).  Material and methods:  this is a transversal, observational and prospective trial in patients older than 18 years, requiring invasive mechanical ventilation, who were put on a SBT trial and in whom the Tfdi and Tfic were measured with ultrasound.  Results:  thirty two patients were recruited, SBT was considered successful in 93.7%, the mechanical ventilation hours median was 90.5 hours (IQR 40.7-164.2). We found a median Tfic of 7.54% (IQR 3.8-9.3), and a Tfdi median of 32.7% (IQR 24.1-40.9). The correlation between the diaphragm shortening fraction and the parasternal intercostal fraction was null (r = 0.076). We found four groups of patients with distinct diaphragmatic and intercostal shortening fraction patterns. A negative correlation between Tfdi and body mass index was found (r = 0.32), and a positive correlation between mechanical ventilation duration and Tfic (r = 0.28). We didn&#8217;t find a statistically significant difference between patients who had a successful SBT and patients who failed, both for Tfdi (p = 0.52) and Tfic (p = 0.79).  Conclusions:  we cannot make a conclusion about the predictive capacity of the diaphragmatic and intercostal shortening fractions on the SBT success. The correlation analysis between diaphragmatic and intercostal thickening fraction suggests four groups of patients, in which both shortening fractions identify different respiratory muscle reserve patterns.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  em pacientes em estado crítico com insuficiência respiratória que necessitam de ventilação mecânica, foi descrita lesão muscular diafragmática que causa falha na desconexão do ventilador. Durante a ventilação mecânica, é exercido um efeito de recrutamento nos músculos acessórios. A ultrassonografia é um método de baixo custo e facilmente reprodutível que pode ser utilizado para avaliar a atividade do diafragma e da musculatura acessória para prever o risco de falha no desmame ventilatório.  Objetivo:  determinar o valor preditivo da fração de espessamento diafragmático (Tfdi) e paraesternal intercostal (Tfic) para falha ou sucesso do teste de ventilação espontânea (TVE).  Material e métodos:  estudo transversal, observacional e prospectivo em pacientes maiores de 18 anos sob ventilação mecânica invasiva nos quais foi realizada TVE e medida da fração Tfdi e Tfic por ultrassonografia.  Resultados:  recrutaram-se 32 pacientes, com TVE bem sucedido em 93.7%, a mediana de horas de ventilação mecânica foi de 90.5 horas (IQR 40.7-164.2). Encontrou-se uma mediana de Tfic de 7.54% (IQR 3.8-9.3). A mediana do Tfdi foi de 32.7% (IQR 24.1-40.9). A correlação entre Tfdi e Tfic foi nula (r = 0.076). Foram identificados quatro grupos de pacientes com diferentes padrões de espessamento intercostal e diafragmático. Encontrou-se uma correlação negativa entre a fração de espessamento diafragmático e o índice de massa corporal (r = 0.32), e uma correlação positiva baixa entre horas de ventilação mecânica e a fração de espessamento intercostal (r = 0.28). Não encontrou-se diferença estatisticamente significativa entre pacientes com sucesso e falha no TVE, tanto para Tfdi (p = 0.52) quanto para Tfic (p = 0.79).  Conclusões:  não podemos concluir quanto à capacidade preditiva de sucesso na TVE de espessamento intercostal e diafragmático devido ao pequeno número de pacientes que falharam na TVE. A análise da correlação entre as frações de espessamento sugere 4 grupos de pacientes, nos quais ambas as frações de espessamento identificam diferentes padrões de reserva muscular respiratória.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[prueba de ventilación espontánea]]></kwd>
<kwd lng="es"><![CDATA[ventilación mecánica]]></kwd>
<kwd lng="es"><![CDATA[ultrasonido]]></kwd>
<kwd lng="es"><![CDATA[fracción de engrosamiento diafragmático]]></kwd>
<kwd lng="es"><![CDATA[fracción de engrosamiento intercostal]]></kwd>
<kwd lng="en"><![CDATA[spontaneous breathing trial]]></kwd>
<kwd lng="en"><![CDATA[mechanical ventilation]]></kwd>
<kwd lng="en"><![CDATA[ultrasound]]></kwd>
<kwd lng="en"><![CDATA[diaphragmatic thickening fraction]]></kwd>
<kwd lng="en"><![CDATA[intercostal thickening fraction]]></kwd>
<kwd lng="pt"><![CDATA[teste de ventilação espontânea]]></kwd>
<kwd lng="pt"><![CDATA[ventilação mecânica]]></kwd>
<kwd lng="pt"><![CDATA[ultrassonografia]]></kwd>
<kwd lng="pt"><![CDATA[fração de espessamento diafragmático]]></kwd>
<kwd lng="pt"><![CDATA[fração de espessamento intercostal]]></kwd>
</kwd-group>
</article-meta>
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