Estudio de la eficacia y seguridad de un dispositivo intraoral de avance mandibular en pacientes roncadores habituales con síndrome de apnea-hipopnea de carácter leve-moderado

184 p. : il.

Aireztapenen maiztasunaren neurketa bihotz biriketako berpiztean kapnografia erabiliz.

[EN]Hyperventilation, which is common both in-hospital and out-of-hospital cardiac arrest, decreases coronary and cerebral perfusion contributing to poorer survival rates in both animals and humans. Current resucitation guidelines recommend continuous monitoring of exhaled carbon dioxide (CO2) during cardiopulmonary resucitation (CPR) and emphasize good quality of CPR, including ventilations at 8-10 min1. Most of commercial monitors/de- brilators incorporate methods to compute the respiratory rate based on capnography since it shows uctuations caused by ventilations. Chest compressions may induce artifacts in this signal making the calculation of the respiratory rate di cult. Nevertheless, the accuracy of these methods during CPR has not been documented yet. The aim of this project is to analyze whether the capnogram is reliable to compute ventilation rate during CPR. A total of 91 episodes, 63 out-of-hospital cardiac arrest episodes ( rst database) and 28 in-hospital cardiac arrest episodes (second database) were used to develop an algorithm to detect ventilations in the capnogram, and the nal aim is to provide an accurate ventilation rate for feedback purposes during CPR. Two graphic user interfaces were developed to make the analysis easier and another two were adapted to carry out this project. The use of this interfaces facilitates the managment of the databases and the calculation of the algorithm accuracy. In the rst database, as gold standard every ventilation was marked by visual inspection of both the impedance, which shows uctuations with every ventilation, and the capnography signal. In the second database, volume of the respiratory ow signal was used as gold standard to mark ventilation instants since it is not a ected by chest compressions. The capnogram was preprocessed to remove high frequency noise, and the rst di erence was computed to de ne the onset of inspiration and expiration. Then, morphological features were extracted and a decission algorithm built based on the extracted features to detect ventilation instants. Finally, ventilation rate was calculated using the detected instants of ventilation. According to the results obtained in this project, the capnogram can be reliably used to give feedback ventilation rate, and therefore, on hyperventilation in a resucitation scenario.

Estudio comparado del grado de oxidependencia en animales intermareales

Uno de los factores limitantes de la vida animal en la zona intermareal es la disponibilidad de oxígeno. En el presente estudio se ha desarrollado un índice para medir el grado de oxidependencia que ha sido aplicado al comportamiento respiratorio para ejemplares de diferentes tamaños del cangrejo intermareal Pachygrapsus marmoratus, con objeto de realizar una aproximación a la relación existente entre la concentración de oxígeno del medio y la tasa de consumo de oxígeno, por una parte, y de ésta con el tamaño de los ejemplares, por otra. La relación entre la tasa de consumo de oxígeno (VO2) y el peso de los ejemplares de P. marmoratus se ajusta a una función potencial. Del valor de b (exponente de la masa) se desprende que existe alometría negativa (b<1) entre la tasa de consumo de oxígeno y el peso de los ejemplares, con lo que se cumple la ley de Kleiber: la tasa metabólica peso-específica se incrementa al reducirse el tamaño de los animales. Con respecto al índice de oxidependencia, se observa que las diferencias no son significativas entre los ejemplares grandes y los medianos pero si lo son entre los ejemplares grandes-medianos y los pequeños. Los grados de oxidependencia en los ejemplares de P. marmoratus grandes y medianos son mayores que en los pequeños. Es decir, en el curso de la hipoxia, los ejemplares más pequeños de P. marmoratus tienen una mayor capacidad de regulación de la tasa de consumo de oxígeno (son mas “oxirreguladores”), que los ejemplares de mayor tamaño (mas “oxiconcordantes”). Se puede concluir pues que el tamaño es una variable a tener en cuenta para las diferencias en el grado de oxidependencia de los animales intermareales, pero sus resultados pueden ser diferentes dependiendo de otro tipo de variables exógenas, como la temperatura o la salinidad.

Long-Term Burden and Respiratory Effects of Respiratory Syncytial Virus Hospitalization in Preterm Infants — The SPRING Study

The health status of premature infants born 32(1)-35(0) weeks' gestational age (wGA) hospitalized for RSV infection in the first year of life (cases; n = 125) was compared to that of premature infants not hospitalized for RSV (controls; n = 362) through 6 years. The primary endpoints were the percentage of children with wheezing between 2-6 years and lung function at 6 years of age. Secondary endpoints included quality of life, healthcare resource use, and allergic sensitization. A significantly higher proportion of cases than controls experienced recurrent wheezing through 6 years of age (46.7% vs. 27.4%; p = 0.001). The vast majority of lung function tests appeared normal at 6 years of age in both cohorts. In children with pulmonary function in the lower limit of normality (FEV1 Z-score [-2; -1]), wheezing was increased, particularly for cases vs. controls (72.7% vs. 18.9%, p = 0.002). Multivariate analysis revealed the most important factor for wheezing was RSV hospitalization. Quality of life on the respiratory subscale of the TAPQOL was significantly lower (p = 0.001) and healthcare resource utilization was significantly higher (p<0.001) in cases than controls. This study confirms RSV disease is associated with wheezing in 32-35 wGA infants through 6 years of age.