<?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>S2448-89092024000600486</article-id>
<article-id pub-id-type="doi">10.35366/119237</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Alteración del comportamiento hemodinámico cerebral posterior al cambio de posición en decúbito prono]]></article-title>
<article-title xml:lang="en"><![CDATA[Cerebral hemodynamic behavior measured by ultrasound before and after prone position]]></article-title>
<article-title xml:lang="pt"><![CDATA[Alteração do comportamento hemodinâmico cerebral após mudança de posição em prono]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Juan Gómez]]></surname>
<given-names><![CDATA[Marco Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Garduño López]]></surname>
<given-names><![CDATA[Jessica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Amezcua Gutiérrez]]></surname>
<given-names><![CDATA[Marcos Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alva Arroyo]]></surname>
<given-names><![CDATA[Nancy V]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zamora Gómez]]></surname>
<given-names><![CDATA[Sergio Edgar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gasca Aldama]]></surname>
<given-names><![CDATA[José Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Juárez de México  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>6</numero>
<fpage>486</fpage>
<lpage>489</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092024000600486&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092024000600486&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092024000600486&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[resumen está disponible en el texto completo]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  The prone position is considered a fundamental maneuver within the treatment pillars in patients with acute respiratory distress syndrome (ARDS). However, the literature that mentions this maneuver does not consider the cerebral hemodynamic changes. The objective of this study was to evaluate the cerebral hemodynamic behavior after the change of position from supine to prone in patients with ARDS, whether of pulmonary or extrapulmonary origin, with or without acute traumatic injury.  Objectives:  To evaluate the alteration of cerebral hemodynamic behavior after changing the prone position.  Material and methods:  A descriptive, observational, prospective study was conducted in a cohort of twenty-six patients admitted to an adult intensive care unit of a third-level hospital over a seven-month period. Patients diagnosed with ARDS who required prone positioning, who had an adequate transtemporal window for evaluation of cerebral hemodynamics by transcranial Doppler ultrasound through the middle cerebral artery, and who gave their informed consent were included.  Results:  Measurements were obtained from twenty-six patients with a diagnosis of ARDS who required prone position. The Kolmogorov-Smirnov test was applied, showing normality of the sample, fifteen were men (57.7%) and eleven were women (42.3%). The admission diagnoses were three neurocritical patients plus ARDS (11.5%) and twenty-three had ARDS only (88.5%). Using the repeated means ANOVA test, statistical significance was shown during the measurements made before and during the prone position, but with stability after the first hour of the prone position, remaining within physiological ranges. An increase in the left and right middle cerebral artery (MCA) flows of the systolic velocity (SV), diastolic velocity (DV) and mean velocity (MV) was evident after performing the prone position (p &lt; 0.001), as well as an increase in pulsatility index (PI), resistive index (RI) and cerebral perfusion pressure (CPP) (p &lt; 0.005); however, they remained stable towards the first hour of the maneuver. In the case of intracranial pressure (ICP), a decrease of up to 1.1 mmHg (p &lt; 0.005) was observed during the prone position.  Conclusions:  It was determined that during the prone position in patients with ARDS, changes in cerebral hemodynamics occurred, measured by transcranial Doppler at the patient&#8217;s bedside, although these changes remained within physiological ranges. Regarding ICP, it was shown that after the prone position, there was even a decrease of up to 1.1 mmHg, so we could consider that the prone position is safe and beneficial for patients with ARDS.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  A posição prona é considerada uma manobra fundamental no tratamento de pacientes com síndrome do desconforto respiratório agudo (SDRA). No entanto, há muito pouca literatura sobre as alterações hemodinâmicas cerebrais quando a manobra é realizada, o que gera receios sobre sua implementação em pacientes com lesão cerebral. O objetivo deste estudo foi avaliar o comportamento hemodinâmico cerebral após a mudança da posição supina para prona em pacientes com SDRA, de origem pulmonar ou extrapulmonar, com ou sem lesão traumática aguda.  Objetivos:  Avaliar a alteração do comportamento hemodinâmico cerebral após mudança de posição a decúbito prono.  Material e métodos:  Foi realizado um estudo descritivo, observacional e prospectivo em uma coorte de 26 pacientes internados em uma unidade de terapia intensiva adulto de um hospital terciário, durante um período de sete meses. Foram incluídos pacientes com diagnóstico de SDRA que necessitaram de manobra de posição prona, que apresentavam janela transtemporal adequada para avaliação da hemodinâmica cerebral por meio do ultrassom Doppler colorido transcraniano pela artéria cerebral média, sendo aplicado o teste de Kolmogorov-Smirnov e o teste ANOVA.  Resultados:  Foram obtidas medidas de 26 pacientes, com diagnóstico de SDRA que necessitava de posição prona, foi aplicado o teste de Kolmogorov-Smirnov, mostrando normalidade da amostra, 15 eram homens (57.7%) e 11 eram mulheres (42.3%). Os diagnósticos de admissão foram 3 pacientes neurocríticos mais SDRA (11.5%) e 23 tinham apenas SDRA (88.5%). Utilizando o teste ANOVA de médias repetidas, ficou evidente a significância estatística durante as medidas realizadas antes e durante a posição prona, mas com estabilidade após a primeira hora de prona, permanecendo dentro dos limites fisiológicos. Evidenciou-se aumento dos fluxos da ACM esquerda e direita do VS, VD e VM após a realização da posição prona (p &lt; 0.001), bem como aumento da IP, IR e PPC (p &lt; 0.005), porém, permaneceu estável na primeira hora da manobra. No caso da PIC, ficou evidente uma diminuição da mesma no momento da posição prona, de até 1.1 mmHg (p &lt; 0.005).  Conclusões:  Foi determinado que, durante a posição prona em pacientes com SDRA, houve alterações na velocidade do fluxo cerebral, medida por Doppler colorido transcraniano à beira do leito do paciente, e que essas alterações permaneceram dentro das faixas fisiológicas. Quanto à PIC, verificou-se que, após o posicionamento em decúbito prono, houve até mesmo uma diminuição de até 1.1 mm Hg, portanto, podemos considerar que a posição em decúbito ventral não tem um impacto deletério na hemodinâmica cerebral, o que é seguro e pode beneficiar os pacientes que também apresentam lesão cerebral.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[hemodinamia cerebral]]></kwd>
<kwd lng="es"><![CDATA[síndrome de distrés respiratorio agudo]]></kwd>
<kwd lng="es"><![CDATA[Doppler transcraneal]]></kwd>
<kwd lng="en"><![CDATA[cerebral hemodynamics]]></kwd>
<kwd lng="en"><![CDATA[acute respiratory distress syndrome]]></kwd>
<kwd lng="en"><![CDATA[transcranial Doppler]]></kwd>
<kwd lng="pt"><![CDATA[hemodinâmica cerebral]]></kwd>
<kwd lng="pt"><![CDATA[síndrome do desconforto respiratório agudo]]></kwd>
<kwd lng="pt"><![CDATA[doppler transcraniano]]></kwd>
</kwd-group>
</article-meta>
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