Carcass, meat quality traits, and economic analysis of Nellore bulls fed with finishing feedlot diets containing mechanically processed corn silage.

Effects of mechanical processing (MP) of corn silage and its inclusion in feedlot diets on carcass and meat quality traits of Nellore (Bos indicus) were analyzed. Seventy-two bulls aged approximately 18 months and with an initial average body weight of 392.8 ± 22.3 kg were used. The experimental design was a 2 × 2 factorial arrangement, considering the concentrate-roughage (C:R) ratio (40:60 or 20:80), MP of silage and their interactions. After slaughter, hot carcass weight (HCW), pH, temperature, backfat thickness (BFT), and ribeye area (REA), yields of meat cuts (tenderloin, striploin, ribeye steak, neck steak, and sirloin cap), meat quality traits and economic analysis were evaluated. A lower final pH was found in the carcasses of animals consuming diets containing MP versus unprocessed silage (pH = 5.81 versus 5.93). Carcass variables (HCW, BFT, and REA) and meat cut yields were not affected by treatments. The C:R 20:80 increased the intramuscular fat (IMF) content by approximately 1%, without affecting moisture, ash, and protein contents. Meat/fat color (L*, a* and b*) and Warner-Bratzler shear force (WBSF) were similar among treatments. The results indicated that the MP of corn silage in finishing diets can provide better carcass pH results in Nellore bulls, without negatively influencing carcass weight, fatness, and meat tenderness (WBSF). The IMF content of meat was slightly improved using a C:R 20:80 and lower total costs per arroba produced (3.5%), daily costs per animal/day (4.2%), and cost per ton of feeds (5.15%) were found with MP silage.

[Use of preoperative planning and 3D printing in orthopedics and traumatology: entering a new era]. / Uso de planificación preoperatoria e impresión 3D en ortopedia y traumatología: ingresando en una nueva era.

Three-dimensional (3D) printing includes a group of technologies by means of which it is possible to generate three-dimensional objects from binary information. Orthopedics and traumatology are fields of medicine in which 3D planning has had the greatest impact, especially in trauma and oncological orthopedics. Applications of this technique include diagnosis, surgical planning, intraoperative guide creation, custom implants, surgical training, orthotic and prosthetic impression, and bioprinting. Advantages have been demonstrated in its use, such as greater technical precision, shorter surgical times, decreased blood loss and less exposure to X-rays. Although the process is increasingly optimized and accessible due to advances in software and automation, it is a technique that requires adequate training. The objective of this review is to offer an approach to this technology and its basic principles.

La impresión en tres dimensiones (3D) incluye un grupo de tecnologías por medio de las cuales es posible generar objetos tridimensionales a partir de información binaria. La ortopedia y traumatología es uno de los campos de la medicina en los que mayor impacto ha tenido la planificación 3D, en especial en trauma y ortopedia oncológica. Las aplicaciones de esta técnica incluyen el diagnóstico, planificación quirúrgica, creación de guías intraoperatorias, implantes personalizados, entrenamiento quirúrgico, impresión de ortesis y prótesis y la bioimpresión. Se han demostrado ventajas en su uso como la mayor precisión técnica, el acortamiento de tiempos quirúrgicos, disminución de pérdida sanguínea y menor exposición a rayos. Si bien el proceso está cada vez más optimizado y accesible por los avances en software y automatización, es una técnica que requiere un entrenamiento adecuado. El objetivo de esta revisión es ofrecer un acercamiento a esta tecnología y sus principios básicos.

Anomalous photoluminescence of InAs surface quantum dots: intensity enhancement and strain control by underlying quantum dots.

Strain control and photoluminescence (PL) enhancement of InAs surface quantum dots (SQDs), exposed to ambient conditions, have been achieved by introducing underlying buried quantum dots (BQDs). The PL wavelength has been tuned from 1270 to as long as 1780 nm, redshifted as the size of the SQDs is reduced. This is in strong contrast to standard QDs, in which blueshift is observed from smaller QDs following basic quantum mechanics. Here, smaller SQDs, both in height and base area, as observed by atomic force microscopy, were obtained with wider GaAs spacer thickness between the SQDs and BQDs. The result strongly suggests that strain and related effects dominate the electronic properties of the SQDs rather than their size, and that a change in the complex strain field occurs through the spacer. The underlying BQDs also serve as effective carrier reservoirs. A PL intensity enhancement of 17 fold was observed as the GaAs spacer thickness was reduced from 150 to 10 nm. A large portion of the photoexcited carriers is initially captured and stored in the BQDs. When sufficient carriers are transferred to fill non-radiative surface states, the excess may be transferred to the SQDs enhancing the luminescence.

Non-destructive Analysis of the Mechanical Properties of 3D-Printed Materials.

The determination of the mechanical properties of materials is predominantly undertaken using destructive approaches. Such approaches are based on well-established mathematical formulations where a physical property of the material is measured as a function of an input under controlled conditions provided by some machine, such as load-displacement curves in indentation tests and stress-strain plots in tensile testing. The main disadvantage of these methods is that they involve destruction of samples as they are usually tested to failure to determine the properties of interest. This means that large sample sizes are required to obtain statistical certainty, a condition that, depending on the material, may mean the process is both time consuming and expensive. In addition, for rapid prototyping and small-batch manufacturing of polymers, these techniques may be inappropriate either due to excessive cost or high polymer composition variability between batches. In this paper we discuss how the Euler-Bernoulli beam theory can be exploited for experimental, non-destructive assessment of the mechanical properties of three different 3D-printed materials: a plastic, an elastomer, and a hydrogel. We demonstrate applicability of the approach for materials, which vary by several orders of magnitude of Young's moduli, by measuring the resonance frequencies of appended rectangular cantilevers using laser Doppler vibrometry. The results indicate that experimental determination of the resonance frequency can be used to accurately determine the exact elastic modulus of any given 3D-printed component. We compare the obtained results with those obtained by tensile testing for comparison and validation.

Uso de planificación preoperatoria e impresión 3D en ortopedia y traumatología: ingresando en una nueva era / Use of preoperative planning and 3D printing in orthopedics and traumatology: entering a new era

Resumen: La impresión en tres dimensiones (3D) incluye un grupo de tecnologías por medio de las cuales es posible generar objetos tridimensionales a partir de información binaria. La ortopedia y traumatología es uno de los campos de la medicina en los que mayor impacto ha tenido la planificación 3D, en especial en trauma y ortopedia oncológica. Las aplicaciones de esta técnica incluyen el diagnóstico, planificación quirúrgica, creación de guías intraoperatorias, implantes personalizados, entrenamiento quirúrgico, impresión de ortesis y prótesis y la bioimpresión. Se han demostrado ventajas en su uso como la mayor precisión técnica, el acortamiento de tiempos quirúrgicos, disminución de pérdida sanguínea y menor exposición a rayos. Si bien el proceso está cada vez más optimizado y accesible por los avances en software y automatización, es una técnica que requiere un entrenamiento adecuado. El objetivo de esta revisión es ofrecer un acercamiento a esta tecnología y sus principios básicos.

Abstract: Three-dimensional (3D) printing includes a group of technologies by means of which it is possible to generate three-dimensional objects from binary information. Orthopedics and traumatology are fields of medicine in which 3D planning has had the greatest impact, especially in trauma and oncological orthopedics. Applications of this technique include diagnosis, surgical planning, intraoperative guide creation, custom implants, surgical training, orthotic and prosthetic impression, and bioprinting. Advantages have been demonstrated in its use, such as greater technical precision, shorter surgical times, decreased blood loss and less exposure to X-rays. Although the process is increasingly optimized and accessible due to advances in software and automation, it is a technique that requires adequate training. The objective of this review is to offer an approach to this technology and its basic principles.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

Algoritmo de movilización temprana para el paciente crítico. Recomendaciones de expertos / Early mobilisation algorithm for the critical patient. Expert recommendations

Introducción La debilidad adquirida en la unidad de cuidados intensivos (DAU) es desarrollada por el 40-46% de los pacientes ingresados en UCI. Diferentes estudios han mostrado que la movilización temprana (MT) es segura, factible, costo-efectiva y mejora los resultados del paciente a corto y largo plazo. Objetivo Diseñar un algoritmo de MT para el paciente crítico en general y enumerar unas recomendaciones para la MT en subpoblaciones específicas de paciente crítico con más riesgo para la movilización: neurocrítico, traumático, sometido a terapias continuas de depuración renal (TCDR) y con dispositivos de asistencia ventricular (DAV) o membrana de oxigenación extracorpórea (ECMO). Metodología Revisión en las bases de datos Medline, CINAHL, Cochrane y PEDro de estudios publicados en los últimos 10 años, que aporten protocolos/intervenciones de MT. Resultados Se incluyeron 30 artículos. De ellos, 21 eran para guiar la MT en el paciente crítico en general, 7 en pacientes neurocríticos y/o traumáticos, uno en pacientes portadores de TCDR y uno en pacientes portadores de ECMO y/o DVA. Se diseñan 2 figuras: una para la toma de decisiones teniendo en cuenta el bundle ABCDEF y la otra con los criterios de seguridad y objetivo de movilidad para cada uno. Conclusiones Los algoritmos de MT aportados pueden promover la movilización precoz (entre el 1.er y 5.o día de ingreso en UCI), junto a aspectos a tener en cuenta antes de la movilización y criterios de seguridad para suspenderla. (AU)

Introduction Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. Objective To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). Methodology Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. Results 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. Conclusions The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it. (AU)

Early mobilisation algorithm for the critical patient. Expert recommendations.

INTRODUCTION: Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE: To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY: Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS: 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS: The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.

Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos / Management of temperature control in post-cardiac arrest care: an expert report

Actualmente, el control estricto de temperatura mediante hipotermia inducida (entre 32 y 36 oC) se considera un tratamiento de primera línea en el manejo de pacientes con parada cardiaca recuperada que ingresan en Unidades de Cuidados Intensivos. Su objetivo es disminuir el daño neurológico secundario a anoxia cerebral. Aunque existen múltiples evidencias sobre sus beneficios, el empleo de esta técnica en nuestro país es pobre y todavía existen temas controvertidos como temperatura óptima, velocidad de instauración, duración y proceso de calentamiento. El objetivo de este trabajo es desarrollar la evidencia científica actual y las recomendaciones de las principales guías internacionales. El enfoque de este documento se centra también en aplicación práctica del control estricto de la temperatura en la parada cardiaca recuperada en nuestras Unidades de Cuidados Intensivos Generales o Cardiológicas, principalmente en los métodos de aplicación, protocolos, manejo de las complicaciones y elaboración del pronóstico neurológico. (AU)

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis. (AU)

High levels of copper and zinc supplementation in broiler diets on growth performance, carcase traits and apparent ileal mineral absorption.

1. This study investigated the effects of hydroxy trace minerals (HTM) compared to sulphate trace minerals (STM) supplementation on growth performance, carcase parameters and mineral retention in broilers.2. A total of 1792 male Cobb 500 d-old were allocated in a completely randomised trial design to one of eight dietary treatments with eight replicates per treatment. The HTM sources used were two levels of Cu hydroxychloride (CHC) (low and high), combined with three levels of Zn hydroxychloride (ZHC) (low, med and high) and two additional treatments STM; Cu sulphate monohydrate (CSM) (low and high) combined with high Zn sulphate monohydrate (ZSM). At 21 and 42 d-old growth performance was evaluated. Additionally, at 42 d-old the carcase traits, meat quality, apparent ileal absorption and activity of antioxidant enzymes were accessed.3. A data showed that broilers receiving high-CHC had higher body weight, weight gain and better feed conversion ratio as compared to low-CHC at 21 d-old. On day 42, the feed conversion ratio was improved for birds supplemented with high-CHC in diets containing med-ZHC, as compared to low-CHC.4. Dietary Cu increased the redness of breast colour at the level of high-CHC compared to low-CHC. Greater results were observed on carcase traits for the med-ZHC group as compared to low- or high-ZHC. The ceruloplasmin activity in serum increased in the high-CSM diets containing high-ZSM as compared to low-CSM. The AIA of Cu was higher in broilers supplemented with high-CHC containing med-ZHC as compared to low-CHC. Otherwise, the AIA of Zn increased in broilers fed low-CHC containing low- or med-ZHC as compared to high-CHC.5. The trial showed that mineral trace supplementation of broilers diets with high-CHC (150 mg/kg) and low-ZHC (80 mg/kg) was a good alternative to replace sulphate mineral sources in diets.

Management of temperature control in post-cardiac arrest care: an expert report. / Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos.

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis.

Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19 / Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por 3 Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse, y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados postoperatorios

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures

Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2 / Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una Unidad de Cuidados Intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials

Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Pérdida visual secundaria a intoxicación inhalatoria y cutánea por metanol y tolueno. A propósito de un caso / Secondary visual loss due to inhalation and cutaneous poisoning by methanol and toluene. Presentation of a clinical case

La intoxicación por ingesta de metanol es una entidad frecuentemente descrita en la literatura, no así la intoxicación vía transdérmica o inhalatoria. Suele cursar con daño multiorgánico variable, entre lo que destaca la afectación visual, neurológica y digestiva, así como las alteraciones metabólicas y electrolíticas que pueden llegar a causar la muerte. El contacto con tolueno por inhalación ocupacional o intencional puede producir también alteraciones neurológicas. En este artículo se expone el caso de una paciente mujer que acude al servicio de urgencias por pérdida visual bilateral secundaria a una intoxicación accidental (inhalatoria-transdérmica) con un disolvente que contenía metanol y tolueno, entre otros compuestos, y que durante el ingreso evoluciona favorablemente tras tratamiento con etanol en perfusión y corticoides

Methanol poisoning is often described in the literature, but not transdermal or inhalational poisoning. It usually involves variable multi-organ damage, among which visual, neurological, and gastrointestinal involvement, as well as the metabolic and electrolyte changes that can lead to death. Contact with toluene by occupational or intentional inhalation may also cause neurological abnormalities. This article describes the case of a female patient who was seen in the Emergency Department due to bilateral visual loss secondary to accidental poisoning (inhalation-transdermal) with a solvent containing methanol and toluene. She had a favourable outcome during admission after treatment with ethanol in perfusion and corticosteroids

Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2 / Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una Unidad de Cuidados Intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials

Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection. / Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

Ecografía pulmonar en paciente con disnea y fiebre en atención primaria / Lung ultrasound in a patient with dyspnoea and fever in primary care

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