<?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>S2448-89092017000400190</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Medición del grosor diafragmático como parámetro predictivo para retiro de ventilación mecánica invasiva en pacientes de terapia intensiva]]></article-title>
<article-title xml:lang="en"><![CDATA[Diaphragmatic thickness measurement as a predictive parameter for removal invasive mechanical ventilation in intensive care patients]]></article-title>
<article-title xml:lang="pt"><![CDATA[Medida do espessamento diafragmático como um parâmetro de predição para a remoção da ventilação mecânica invasiva em pacientes em terapia intensiva]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tanaka Montoya]]></surname>
<given-names><![CDATA[Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Amador Martínez]]></surname>
<given-names><![CDATA[Ana del Carmen]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Delgado Mercado]]></surname>
<given-names><![CDATA[Lucía Yunnuen]]></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 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[Camarena Alejo]]></surname>
<given-names><![CDATA[Gilberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Centro Médico ABC  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2017</year>
</pub-date>
<volume>31</volume>
<numero>4</numero>
<fpage>190</fpage>
<lpage>197</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092017000400190&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092017000400190&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092017000400190&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  La medición del engrosamiento diafragmático y el cambio de grosor en espiración e inspiración del mismo pueden utilizarse para predecir el éxito o fracaso en la extubación. Se evaluó la fracción de grosor diafragmático (FGD) por ultrasonido en pacientes de terapia intensiva y se comparó con índice de ventilación rápida superficial (VRS).  Métodos:  Los 65 pacientes con ventilación mecánica invasiva fueron reclutados prospectivamente en el Departamento de Medicina Crítica del Centro Médico ABC en un periodo de nueve meses, de agosto de 2015 a abril de 2016. La FGD se midió en la zona de aposición del diafragma al tórax en ambos hemitórax, utilizando un transductor de ultrasonido 4 MHz y el médico radiólogo realizó el procedimiento en todos los pacientes sin conocimiento de patologías. Los pacientes reclutados fueron sometidos a una prueba de respiración espontánea (PRE) cuando se reunieron los siguientes criterios: FiO2 &lt;50%, la PEEP &#8804; 5 cm de H2O, PaO2/FiO2 &gt; 200, frecuencia respiratoria &lt; 30 por minuto, ausencia de fiebre, neurológicamente alerta y sin el apoyo hemodinámico de vasopresores. Se calculó el porcentaje de cambio en FGD, siendo el final de la inspiración y el final de la espiración entre el final de la espiración en pacientes con ventilación mecánica invasiva en modalidad de ventilación presión soporte con progresión ventilatoria con fines de extubación. El éxito en la extubación se definió como respiración espontánea &gt; 48 horas sin soporte ventilatorio después del retiro de tubo endotraqueal.  Resultados:  De los 65 pacientes reclutados, 23 (35.4%) fueron mujeres y 42 (64.6%) hombres, índice de masa corporal (IMC), de 25.83 (DE ± 4.19) todos fueron extubados en modalidad de ventilación presión soporte. La frecuencia de falla en la extubación fue de 21.5% y la mortalidad de 24.6%. Las variables asociadas a fracaso fueron valores de corte de FGD derecho 25.9%, FGD 23.1% izquierdo. Tiempo de ventilación mecánica en días con mediana de 4 (RIQ 3-6) versus 8.5 (RIQ 7-11), p &lt; 0.001 y VRS con 68.2 ± 9.6 versus 53.9 ± 11.1, p &lt; 0.001. Las variables obtenidas a partir de las mediciones USG fueron las siguientes: grosor diafragmático derecho al final de la espiración (RTEEx) 0.28 ± 0.05 cm, grosor diafragmático derecho al final de la inspiración (RTEI) 0.21 ± 0.05 cm, índice de grosor diafragmático derecho (RDTi) 0.76 ± 0.11 cm, índice de fracción diafragmática derecha (RDFi) 23.1 ± 10.7%. El valor predictivo positivo y el valor predictivo negativo fueron de 92 y 64%, respectivamente. El área bajo la curva ROC fue de 0.79 para FGD.  Conclusiones:  Las mediciones de grosor diafragmático por ultrasonido tanto VRS como de tiempo de ventilación mecánica son un parámetro útil para predecir el éxito o el fracaso de la extubación. Índice de ventilación rápida superficial (VRS) con una media de 57.0 ± 12.3 puntos. Este estudio demuestra que no hay relación entre falla a la extubación con EPOC, IMC y edad. La extubación es un procedimiento conjunto y entre más parámetros para extubación menor riesgo de presentar falla.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[bstract:  Introduction:  By measuring diaphragmatic thickening and thickness change in expiration and inspiration, it can be used as a measure to predict the success or failure of extubation. The fraction of diaphragmatic thickness (FDT) was assessed by ultrasound in intensive care patients.  Methods:  65 patients with invasive mechanical ventilation were recruited prospectively at the Department of Critical Care Medicine ABC Medical Center. The FDT was measured in the area of apposition of the diaphragm to the chest in both hemithorax, using an ultrasound transducer of 4 MHz. Patients underwent a spontaneous breathing trial (SBT) when they met all the following criteria are: FiO2 &lt; 50%, PEEP &#8804; 5 cmH2O, PaO2/FiO2 &gt; 200, respiratory rate &lt; 30 per minute, absence of fever, neurologically alert and without hemodynamic vasopressor support. The percentage change in FDT was calculated between the end of expiration and end of inspiration in patients with invasive mechanical ventilation with pressure support ventilation mode, all patients with ventilatory progression purposes extubation. A successful extubation was defined as spontaneous breathing &gt; 48 hours without ventilatory support after removal of the endotracheal tube.  Results:  We included data obtained from 65 patients, 23 (35.4%) women and 42 (64.6%) men, mean Body Mass Index (BMI) of 25.83 (SD ± 4.19). The frequency of extubation failure was 21.5%, and mortality 24.6%. The variables associated with failure were cut-off values of DTF right 25.9%, DTF 23.1% left. Time of mechanical ventilation in days with a median of 4 (RIQ 3-6) versus 8.5 (RIQ 7-11), p &lt;0.001 and RSBI with 68.2 ± 9.6 versus 53.9 ± 11.1, p &lt; 0.001. The variables obtained from USG measurements were as follows: right thickness at end expiration (RTEEx) 0.28 ± .05 cm, right thickness at end inspiration (RTEIs) 0.21 ± .05 cm, right diaphragmal thickness (RDTi) 0.76 ± 0.11 cm, right diaphragmatic fraction index (RDFi) 23.1 ± 10.7%. The positive predictive value and negative predictive value were 92 and 64%, respectively. The area under the ROC curve was 0.79 for DTF.  Conclusions:  Diaphragmatic thickness measurements by ultrasound can be a useful parameter to predict the success or failure of extubation during ventilatory progression in patients with invasive mechanical ventilation. Rapid shallow breathing index (RSBI) with a mean of 57.0 ± 12.3 points. This study demonstrates that there is no relation between failure to extubation with COPD, BMI and age. Extubation is a joint procedure and the more parameters for extubation, the lower the risk of failure.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  Ao medir o espessamento do diafragma e a mudança da espessura na exalação e inalação da mesma, pode ser usado como uma medida para prever o sucesso ou a falha da extubação. Avaliou-se a fração de espessamento do diafragma (FED) por meio de ultra-som em doentes na terapia intensiva e se comparou com o índice de respiração superficial e rápida (IRRS).  Métodos:  Os 65 pacientes com ventilação mecânica invasiva foram recrutados no departamento de medicina crítica do Centro Médico ABC em um período de 9 meses, agosto de 2015 abril de 2016. A FED foi medida na zona de aposição do diafragma ao tórax, em ambos hemitórax, usando um transdutor de ultra-som de 4 MHz e realizou-se por um radiologista em todos os doentes, sem saber as patologias do paciente. Os pacientes recrutados foram submetidos a teste de respiração espontânea (TRE) quando os seguintes critérios foram reunidos: FiO2 &lt; 50%, PEEP &#8804; 5 cmH2O, PaO2/FiO2 &gt; 200, frequência respiratória &lt; 30 por minuto, afebril, neurologicamente alerta e sem suporte hemodinâmico de vasopressores. Calculou-se a percentagem de alteração na FED, sendo o final da inspiração e o final da expiração entre o final da expiração, em pacientes com ventilação mecânica invasiva em modo ventilação de pressão suporte com progressão ventilatória com fins de extubação. A extubação bem sucedida foi definida como espontâneos de respiração &gt; 48 horas sem suporte ventilatório após a remoção do tubo endotraqueal.  Resultados:  Dos 65 pacientes recrutados, 23 (35.4%) mulheres e 42 (64.6%) homens, índice de massa corporal (IMC) de 25.83 (± SD 4.19) todos foram extubados no modo ventilação de pressão suporte. A frequência de falha na extubação foi de 21.5% e mortalidade de 24.6%. As variáveis associadas ao fracasso foram valores de corte da FED direito 25.9%, FED 23.1% esquerdo. Tempo de ventilação mecânica em dias com uma mediana de 4 (IQR 3-6) vs. 8.5 (IQR 7-11), p &lt; 0.001 e VRS com 68.2 ± 9.6 vs 53.9 ± vs 11.1, p &lt; 0.001.  Conclusões:  As medições da espessura diafragmática por ultra-som tanto de RSV como o tempo de ventilação mecânica é um parâmetro útil para prever o sucesso ou a falha da extubação. Este estudo demonstra que não há relação entre pacientes com EPOC, IMC, idade e falha na extubação. A extubação é um procedimento conjunto e entre mais parâmetros para extubação menor o risco de apresentar falha.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Diagragma]]></kwd>
<kwd lng="es"><![CDATA[falla a la extubación]]></kwd>
<kwd lng="es"><![CDATA[ultrasonido]]></kwd>
<kwd lng="en"><![CDATA[Diaphragm]]></kwd>
<kwd lng="en"><![CDATA[extubation failure]]></kwd>
<kwd lng="en"><![CDATA[ultrasound]]></kwd>
<kwd lng="pt"><![CDATA[Diafragma]]></kwd>
<kwd lng="pt"><![CDATA[falha de extubação]]></kwd>
<kwd lng="pt"><![CDATA[ultra-som]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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