<?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>S2448-89092017000100007</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Utilidad del ultrasonido de pulmón en la titulación de la PEEP en pacientes con síndrome de insuficiencia respiratoria aguda clasificación Berlín moderado y grave]]></article-title>
<article-title xml:lang="en"><![CDATA[Utility of lung ultrasound for PEEP titration in patients with acute respiratory distress syndrome with Berlin classification moderate and severe]]></article-title>
<article-title xml:lang="pt"><![CDATA[Utilidade do ultrassom pulmonar na titulação da PEEP em pacientes con síndrome de dificuldade respiratória aguda classificação Berlim moderada e grave]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Torres Aguilar]]></surname>
<given-names><![CDATA[Oscar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez Prieto]]></surname>
<given-names><![CDATA[Guadalupe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Castillejos Suastegui]]></surname>
<given-names><![CDATA[Humberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Monares Cepeda]]></surname>
<given-names><![CDATA[Enrique]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aguirre Sánchez]]></surname>
<given-names><![CDATA[Janet]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Franco Granillo]]></surname>
<given-names><![CDATA[Juvenal]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital ABC  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>02</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>02</month>
<year>2017</year>
</pub-date>
<volume>31</volume>
<numero>1</numero>
<fpage>7</fpage>
<lpage>15</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092017000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092017000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092017000100007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: La ventilación mecánica es una de las herramientas que tenemos en el manejo del síndrome de insuficiencia respiratoria aguda (SDRA); la PEEP es una de las variables que nos permiten mejorar a estos pacientes. El ultrasonido de pulmón es cada vez más empleado en terapia intensiva, por lo que incorporarlo de forma rutinaria a la titulación de la PEEP (presión positiva al final de la espiración) puede ser un acierto. Realizamos de manera prospectiva la titulación de la PEEP en 20 individuos con SDRA y se efectuaron mediciones al pie de cama por medio de ultrasonido de pulmón.  Objetivos: Objetivo primario: Evaluar la utilidad del ultrasonido pulmonar (USP) para la titulación de la PEEP. Objetivo secundario: Analizar diferentes métodos de titulación de la PEEP y analizar la respuesta a la PEEP con base en el potencial de reclutamiento calculado por USP.  Material y métodos:  Estudio prospectivo y observacional. Criterios de inclusión: Sujetos mayores de 18 años con SDRA moderado y severo de acuerdo a la clasificación de Berlín.  Resultados:  Veinte personas (p), 11 hombres (55%), nueve mujeres (45%); 16 (80%) con PaO2/FiO2 &#8804; 150 mmHg y cuatro (20%) con PaO2/FiO2 &gt; 150 mmHg. BNP en 19 p (95%); de estos, 11 (57%) &#8804; 250 ng/dL y nueve (42.2%) &gt; 250 ng/dL. En 17 p (85%) se evidenció potencial de reclutamiento, representado por incremento de distensibilidad de 1 mL/cmH2O y disminución de 1% del espacio muerto. En la titulación por curva de flujos lentos, el punto de inflexión inferior fue en promedio 7.2 cmH2O, el superior, 21.9 cmH2O, el medio, 13.5 cmH2O; el volumen inferior, 105.1 mL, el volumen superior, 428.7 mL. Se tituló la PEEP por mejor distensibilidad en 19 p (95%), programándose 16 cmH2O en 5 p (26%), 14 cmH2O (15.7%), 12 cmH2O (21%), 10 cmH2O (15.7%) y 8 cmH2O (26.3%). Se logró realizar USP en 14 p (70%).  Conclusiones: Realizar USP a la cabecera del enfermo es factible y útil en la titulación de la PEEP sin riesgos. Es otra herramienta en la identificación de sobredistensión pulmonar.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Mechanical ventilation is a cornerstone in the management of acute respiratory distress syndrome (ARDS). PEEP is a strategy that improves the patient&#8217;s outcome. Lung ultrasound is now a main tool in the intensive care unit; therefore, it could have a role in the titration of PEEP. We conducted a prospective study in 20 patients with ARDS, and titrated PEEP with lung ultrasound at the bedside.  Objectives:  Primary objective: Assessing the usefulness of lung ultrasound for PEEP titration in ARDS. Secondary objective: To compare four methods of PEEP titration with lung ultrasound findings.  Material and methods:  Prospective and observation study. Inclusion criteria: Patients with moderate and severe ARDS according to the Berlin classification, 18 years and older.  Results:  Twenty patients (p), 11 males (55%), nine females (45%); 16 (80%) with PaO2/FiO2 &#8804; 150 mmHg and four (20%) with PaO2/FiO2 &gt; 150 mmHg. BNP in 19 p (95%); 11 of them (57%) &#8804; 250 ng/dL and nine (42.2%) &gt; 250 ng/dL. In 17 p (85%), a recruitment potential was observed, represented by an increase of compliance by 1 mL/cmH2O or decrease of 1% in death space. Using slow-flow curve, the mean lower inflection point was 7.2 cmH2O, the upper inflection point was 21.9 cmH2O, and the middle was 13.5 cmH2O; the lower volume, 105.1 mL, the higher volume, 428.7 mL. The best compliance method was also performed on 19 of these patients (95%); then, PEEP was titrated in 16 cmH2O in 5p (26%), 14 cmH2O (15.7%), 12 cmH2O (21%), 10 cmH2O (15.7%) and 8 cmH2O (26.3%). Lung ultrasound could be performed in 14 patients (70%).  Conclusions:  It is feasible to perform a lung ultrasound at the patient&#8217;s bedside. It may be useful in the titration of PEEP, without risks for the patient. It may be another tool for the prevention of lung overdistension.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: A ventilação mecânica é uma das ferramentas que temos no tratamento da dificuldade respiratória aguda (SDRA), a PEEP é uma das variáveis que nos permitem melhorar estes pacientes. O ultrassom pulmonar é cada vez mais utilizado na terapia intensiva, a incorporação rotinária da titulação da PEEP pode ser uma boa opção. Realizamos de maneira prospectiva a titulação da PEEP em 20 pacientes com SDRA e se efetuaram medições à beira do leito mediante ultrassom pulmonar.  Objetivos: Objetivo primário: avaliar a utilidade do ultrassom pulmonar (USP) para a titulação da PEEP. Objetivo secundário: comparar 4 métodos de titulação da PEEP com achados ultrassonográficos no pulmão (USP).  Material e métodos:  Estudo prospectivo e observacional. Critérios de inclusão: pacientes com SDRA moderada e grave de acordo com a classificação de Berlin, maiores de 18 anos.  Resultados:  20 pacientes (p), 11 homens (55%), 9 mulheres (45%), 16 (80%) com PaO2/FiO2 &#8804;150 mmHg e 4 (20%) PaO2/FiO2 &gt; 150 mmHg, BNP em 19 p (95%) destes 11 (57%) &#8804; 250 ng/dL e 9 (42.2%) &gt; 250 ng/dL, em 17 p (85%) se evidenciou potencial de recrutamento, representado pelo aumento na distensibilidade 1 mL/cm H2O e diminuição de 1% do espaço morto. Na titulação pela curva de fluxos lentos o ponto de inflexão inferior, foi em média, 7.2 cmH2O, o superior 21.9 cmH2O, o médio 13.5 cmH2O, o volume inferior 105.1 mL, o volume superior 428.7 mL. PEEP foi titulada por uma melhor distensibilidade em 19 p (95%), programando 16 cmH2O em 5 p (26%), 14 cmH2O (15.7%), 12 cmH2O (21%), 10 cmH2O (15.7%) e 8 cmH2O (26.3%). Realizamos USP em 14 p (70%).  Conclusões:  Realizar USP à beira do leito é viável e é útil na titulação da PEEP sem riscos. É uma outra ferramenta para a identificação de hiperdistensão pulmonar.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Ultrasonido de pulmón]]></kwd>
<kwd lng="es"><![CDATA[PEEP]]></kwd>
<kwd lng="es"><![CDATA[síndrome de insuficiencia respiratoria aguda]]></kwd>
<kwd lng="en"><![CDATA[Lung ultrasound]]></kwd>
<kwd lng="en"><![CDATA[PEEP]]></kwd>
<kwd lng="en"><![CDATA[acute respiratory distress syndrome]]></kwd>
<kwd lng="pt"><![CDATA[Ultrassom pulmonar]]></kwd>
<kwd lng="pt"><![CDATA[PEEP]]></kwd>
<kwd lng="pt"><![CDATA[síndrome de dificuldade respiratória aguda]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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