Scientific Letter
Ultrasound-guided recruitment maneuvers in pediatric acute chest syndrome due to sickle cell disease
Maniobras de reclutamiento guiadas por ecografía en el síndrome torácico agudo en niños con drepanocitosis
S. Bobillo-Pereza,b,
, J. Rodriguez-Fanjulc, M. Girona-Alarcona, F.J. Cambraa, I. Jordana,d, M. Balaguera
Autor para correspondencia
a Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, University of Barcelona, Barcelona, Spain
b Disorders of Immunity and Respiration of the Pediatric Critical Patients Research Group, Institut de Recerca Hospital Sant Joan de Deu, Barcelona, Spain
c Pediatric Intensive Care Unit Service, Pediatric Department, Hospital Universitari de Tarragona Joan XXIII, Institut Catala de la Salut Camp de Tarragona, Spain
d Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Paediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
Leído
4579
Vecesse ha leído el artículo
1747
Total PDF
2832
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S021056911930172X" "issn" => "02105691" "doi" => "10.1016/j.medin.2019.06.002" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1357" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2021;45:184-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6 "formatos" => array:2 [ "HTML" => 3 "PDF" => 3 ] ] "itemSiguiente" => array:19 [ "pii" => "S0210569119301305" "issn" => "02105691" "doi" => "10.1016/j.medin.2019.04.005" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1346" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2021;45:187-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 18 "formatos" => array:2 [ "HTML" => 10 "PDF" => 8 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "«Fibrinólisis de rescate» tras angioplastia primaria fallida" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "187" "paginaFinal" => "189" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "“Rescue fibrinolysis” after failed primary percutaneous coronary intervention" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1287 "Ancho" => 2083 "Tamanyo" => 214685 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A)<span class="elsevierStyleHsp" style=""></span>Lesión crítica ostial (flecha) de la coronaria derecha con flujo anterógrado normal. B)<span class="elsevierStyleHsp" style=""></span>Resultado de la implantación de un stent farmacoactivo en la coronaria derecha proximal (flecha) con mínima protrusión en la raíz aórtica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Teresa Alvarado Casas, Guillermo Diego Nieto, Antonio Manuel Rojas González, Paula Antuña Álvarez, Fernando Rivero Crespo, Fernando Alfonso" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Teresa" "apellidos" => "Alvarado Casas" ] 1 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Diego Nieto" ] 2 => array:2 [ "nombre" => "Antonio Manuel" "apellidos" => "Rojas González" ] 3 => array:2 [ "nombre" => "Paula" "apellidos" => "Antuña Álvarez" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Rivero Crespo" ] 5 => array:2 [ "nombre" => "Fernando" "apellidos" => "Alfonso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572721000035" "doi" => "10.1016/j.medine.2021.01.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721000035?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119301305?idApp=WMIE" "url" => "/02105691/0000004500000003/v1_202103261006/S0210569119301305/v1_202103261006/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0210569120303399" "issn" => "02105691" "doi" => "10.1016/j.medin.2020.10.006" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1604" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2021;45:175-83" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Puesta al día en Medicina Intensiva Perioperatoria</span>" "titulo" => "Manejo perioperatorio en cirugía cardiovascular" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "175" "paginaFinal" => "183" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Perioperative management in cardiovascular surgery" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3655 "Ancho" => 2513 "Tamanyo" => 732471 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Propuesta de algoritmo de manejo del síndrome de bajo gasto postoperatorio. GEDVI: volumen telediastólico global de ventrículo izquierdo; PAM: presión arterial media; POAP: presión de oclusión arterial pulmonar; PVC: presión venosa central; SvO<span class="elsevierStyleInf">2</span>: Saturación venosa mixta de oxígeno; SvcO<span class="elsevierStyleInf">2</span>: Saturación venosa central de oxígeno; TDVI: telediastólica de ventrículo izquierdo; VD: ventrículo derecho; VI: ventrículo izquierdo; VS<span class="elsevierStyleInf">VI</span>: volumen sistólico de ventrículo izquierdo.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">*Adaptado de Habicher M et al<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">18</span></a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.J. Jiménez Rivera, C. Llanos Jorge, M.J. López Gude, J.L. Pérez Vela" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Jiménez Rivera" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Llanos Jorge" ] 2 => array:2 [ "nombre" => "M.J." "apellidos" => "López Gude" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "Pérez Vela" ] 4 => array:1 [ "colaborador" => "en representación del GTCICYRCP" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572721000072" "doi" => "10.1016/j.medine.2020.10.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721000072?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569120303399?idApp=WMIE" "url" => "/02105691/0000004500000003/v1_202103261006/S0210569120303399/v1_202103261006/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Ultrasound-guided recruitment maneuvers in pediatric acute chest syndrome due to sickle cell disease" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "184" "paginaFinal" => "186" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Bobillo-Perez, J. Rodriguez-Fanjul, M. Girona-Alarcon, F.J. Cambra, I. Jordan, M. Balaguer" "autores" => array:6 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Bobillo-Perez" "email" => array:1 [ 0 => "sbobillo@sjdhospitalbarcelona.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Rodriguez-Fanjul" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Girona-Alarcon" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F.J." "apellidos" => "Cambra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "I." "apellidos" => "Jordan" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Balaguer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, University of Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Disorders of Immunity and Respiration of the Pediatric Critical Patients Research Group, Institut de Recerca Hospital Sant Joan de Deu, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pediatric Intensive Care Unit Service, Pediatric Department, Hospital Universitari de Tarragona Joan XXIII, Institut Catala de la Salut Camp de Tarragona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Paediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Maniobras de reclutamiento guiadas por ecografía en el síndrome torácico agudo en niños con drepanocitosis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2301 "Ancho" => 2167 "Tamanyo" => 343634 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 1. (1) Initial chest radiography preceding alveolar recruitment, right coalescent opacities with right pleural effusion (black narrow). (2) Lung ultrasound image preceding lung recruitment, exhibiting diffuse abnormal pulmonary aeration with condensation pattern (white star) on the right anterior, lateral and posterior regions. (3) Chest-X radiography after VNI recruitment. Similar coalescent opacities in right lung (black star) without pleural effusion. (4) Lung ultrasound reveals the presence of sonographic air bronchograms representing air-filled bronchi with linear, hyperechoic branching echoes toward pleural lung. The consolidated lung parenchyma has improved with respect to Image 2.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sickle cell disease (SCD) is an inherited pathology based on structural alteration of hemoglobin and characterized by vaso-occlusive crises<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> with a prevalence of one million worldwide. Acute chest syndrome (ACS) is the main life-threatening complication. Until now ACS diagnostic criteria was based on clinical evaluation and chest X-ray (CXR). These patients often require non-invasive ventilation (NIV) to lung recruitment and oxygenation improvement. NIV parameters are indicated according to clinical variables, oxygen requirements and sequentially CXR data. Although lung ultrasound (LUS) could provide information for both diagnosis and evolution, it has never been tested in pediatrics population.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present two cases of LUS of SCD admitted to pediatric intensive care unit (PICU) due to ACS with respiratory failure.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 7-year-old girl with SCD underwent a minor elective surgery (inguinal hernia). At 24<span class="elsevierStyleHsp" style=""></span>h, presented a subsequent clinical deterioration determined by persistent cough, progressive tachypnea, inspiratory crackles, with right basal hypoventilation and fever despite preventing measures according to SCD local protocol. CXR showed bilateral and right superior lobe infiltrates with minor pleural effusion. Serial LUS were performed during PICU admission. First ultrasound showed a global consolidation of the entire right lung with an associated pleural effusion of 0.5<span class="elsevierStyleHsp" style=""></span>cm. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows both images. NIV was initiated with maxim parameters of IPAP 18 and EPAP 8 cmH<span class="elsevierStyleInf">2</span>O, and a FiO<span class="elsevierStyleInf">2</span> up to 60%, requiring red cell transfusion. During the successive ultrasound controls, progressive lung improvement was observed with an increase in lung aeration to almost complete resolution. Serial CXR changes were less evident. Both images can be compared in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. NIV support was gradually decreased being suspended after 7 days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">An 8-year-old girl with SCD was admitted to the emergency department due respiratory failure and fever with a pathologic CXR in which left lower lobe infiltration was observed. Due to ACS suspicion, patient was transferred to the PICU for early respiratory support. On admission, LUS showed left lung global collapse with 0.3<span class="elsevierStyleHsp" style=""></span>cm pleural effusion. Both images can be compared in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. NIV was initiated to optimize respiratory support, requiring CPAP up to 8<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and FiO<span class="elsevierStyleInf">2</span> up to 50%. Clinical and ultrasonographic evolution was favorable, allowing the suspension of support in the following 48<span class="elsevierStyleHsp" style=""></span>h. CXR image after VNI lung recruitment can be compared in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Thanks to lung ultrasound bedside controls, PEEP parameters were increased until an improvement in lung aeration in both patients. Moreover, while the echographic and clinical improvement was simultaneous, CXR did not reveal major changes.</p><p id="par0030" class="elsevierStylePara elsevierViewall">ACS is the main cause of PICU admission in patients with SCD.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Its diagnosis is based on the confluence of fever and/or respiratory symptoms accompanied by new infiltrate on the CXR. It is essential to have a high index of suspicion for early diagnosis and treatment support.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Respiratory process ethiology can be several: infectious (bacterial, viral), fatty embolism in the context of a vasoocclusive crisis, or by pulmonary vascular micro infarcts due to hypoventilation secondary to atelectasis. Clinical presentation can be wide from a moderate respiratory process to an acute respiratory distress syndrome (ARDS) and even leading to a multiorgan failure. There is already experience in the support of ACS in adults on extracorporeal oxygenation membrane (ECMO).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Some of the radiological signs which can be found are both lobular and multilobar presence consolidations, or pulmonary collapse, in some cases associated with pleural effusion. However, CXR may be normal in early stages in up to 66% of the cases,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> so that the suspicion of ACS was because of the hypoxemia.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">LUS use has increased in recent years in the diagnosis of multiple lung processes. However, it has not been previously described the LUS use for diagnosis and follow-up of ACS in pediatrics. An adults study published in 2015<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> compared the usefulness of CXR versus LUS in the diagnosis of ACS, using CT-based tomography as the reference standard. In this study, they described three patterns in the lung parenchyma: normal, ground-glass opacity and consolidation. In accordance with these patterns, LUS was evaluated in 12 lung regions (6 in each hemithorax), associating a score of 0–2, respectively. Normal pattern was defined by the presence of non-coalescing B lines or by lung sliding with A lines, ground-glass opacities were defined by the presence of coalescing B lines and consolidation by punctate hyperechogenic images. According to this score, they evaluated the lung aeration of each patient and saw that a higher score assessed by LUS was associated with worse posterior evolution. They also proved that LUS was superior to radiography for diagnosis consolidations and pleural effusion in these patients, presenting a greater sensitivity (72% versus 44%), especially in the assessment of the post-basal regions.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In our patients, ultrasound shows a higher degree of lesion than that assessed by radiography, as in the study by Rahmouni et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> of 2016.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There is currently no experience in pediatrics for diagnosis ACS using LUS. Moreover there are no studies about lung recruitment maneuvers guided by ultrasound in children. Ultrasound-controlled lung recruitment is well-defined in adults with several articles emphasizing its usefulness as a bedside tool<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–10</span></a> in ARDS, even though in the evaluation of aeration of ventilated patients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our patients, LUS allowed to confirm the ACS and lung collapse diagnosis. It was also useful to follow-up the lung recruitment improvement, helping to assess the NIV parameters. However, more studies are needed in pediatric population to confirm our experience.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2301 "Ancho" => 2167 "Tamanyo" => 343634 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 1. (1) Initial chest radiography preceding alveolar recruitment, right coalescent opacities with right pleural effusion (black narrow). (2) Lung ultrasound image preceding lung recruitment, exhibiting diffuse abnormal pulmonary aeration with condensation pattern (white star) on the right anterior, lateral and posterior regions. (3) Chest-X radiography after VNI recruitment. Similar coalescent opacities in right lung (black star) without pleural effusion. (4) Lung ultrasound reveals the presence of sonographic air bronchograms representing air-filled bronchi with linear, hyperechoic branching echoes toward pleural lung. The consolidated lung parenchyma has improved with respect to Image 2.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2265 "Ancho" => 2167 "Tamanyo" => 269057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 2. (A) Initial chest radiography before lung recruitment. Coalescent opacities in left lower lobe (black arrow). No pleural effusion observed. (B) Lung ultrasound image before VNI lung recruitment. Tissular pattern suggesting consolidation (white star). No air bronchogram is observed. The lung partner is similar to the spleen pattern (white point). White arrow shows the doble-rail image of the diaphragm. (C) Chest-X radiography after recruitment. Area of hazy with increased lung opacity (black star).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sickle cell disease in the ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Cecchini" 1 => "M. Fartoukh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0000000000000258" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "569" "paginaFinal" => "575" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26539931" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of children with sickle cell disease admitted to intensive care – a single institution experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Bartram" 1 => "S.L. Thein" 2 => "K. Gardner" 3 => "Y. Egberongbe" 4 => "P.D. Silva" 5 => "S.E. Height" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Haematol" "fecha" => "2010" "volumen" => "150" "paginaInicial" => "614" "paginaFinal" => "617" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guideline on the management of acute chest syndrome in sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Howard" 1 => "N. Hart" 2 => "M. Roberts-harewood" 3 => "M. Cummins" 4 => "M. Awogbade" 5 => "B. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.13348" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2015" "volumen" => "169" "paginaInicial" => "492" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25824256" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation for the treatment of adult sickle cell acute chest syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Parhar" 1 => "B. Parizkova" 2 => "N. Jones" 3 => "K. Valchanov" 4 => "J. Fowles" 5 => "M. Besser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0267659115593172" "Revista" => array:6 [ "tituloSerie" => "Perfusion" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "262" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26130498" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluación de veintitrés episodios de síndrome torácico agudo en pacientes con drepanocitosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Solís" 1 => "M. Molina" 2 => "A. Bravo" 3 => "M. Francia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2005" "volumen" => "62" "paginaInicial" => "221" "paginaFinal" => "228" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside lung ultrasound during acute chest syndrome in sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Rahmouni" 1 => "B. Maître" 2 => "C. Brun-buisson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2016" "volumen" => "95" "paginaInicial" => "1" "paginaFinal" => "8" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Bouhemad" 1 => "H. Brisson" 2 => "M. Le-Guen" 3 => "C. Arbelot" 4 => "Q. Lu" 5 => "J.J. Rouby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201003-0369OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "183" "paginaInicial" => "341" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20851923" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonography for the assessment of lung recruitment maneuvers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Tusman" 1 => "C.M. Acosta" 2 => "M. Costantini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13089-016-0045-9" "Revista" => array:5 [ "tituloSerie" => "Crit Ultrasound J" "fecha" => "2016" "volumen" => "8" "paginaInicial" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27496127" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging in acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Pesenti" 1 => "G. Musch" 2 => "D. Lichtenstein" 3 => "F. Mojoli" 4 => "M.B.P. Amato" 5 => "G. Cinnella" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "686" "paginaFinal" => "698" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modern methods of assessment of lung aeration during mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Wierzejski" 1 => "J. Adamski" 2 => "W. Weigl" 3 => "A. Gerega" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anaesthesiol Intensive Ther" "fecha" => "2012" "volumen" => "44" "paginaInicial" => "226" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23348492" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004500000003/v1_202103261006/S021056911930172X/v1_202103261006/en/main.assets" "Apartado" => array:4 [ "identificador" => "53" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004500000003/v1_202103261006/S021056911930172X/v1_202103261006/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056911930172X?idApp=WMIE" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 3 | 9 | 12 |
| 2024 Octubre | 60 | 71 | 131 |
| 2024 Septiembre | 62 | 44 | 106 |
| 2024 Agosto | 63 | 53 | 116 |
| 2024 Julio | 48 | 35 | 83 |
| 2024 Junio | 85 | 80 | 165 |
| 2024 Mayo | 62 | 35 | 97 |
| 2024 Abril | 39 | 45 | 84 |
| 2024 Marzo | 53 | 31 | 84 |
| 2024 Febrero | 49 | 46 | 95 |
| 2024 Enero | 64 | 31 | 95 |
| 2023 Diciembre | 43 | 44 | 87 |
| 2023 Noviembre | 66 | 58 | 124 |
| 2023 Octubre | 59 | 34 | 93 |
| 2023 Septiembre | 40 | 40 | 80 |
| 2023 Agosto | 35 | 15 | 50 |
| 2023 Julio | 64 | 27 | 91 |
| 2023 Junio | 65 | 29 | 94 |
| 2023 Mayo | 71 | 35 | 106 |
| 2023 Abril | 68 | 30 | 98 |
| 2023 Marzo | 96 | 30 | 126 |
| 2023 Febrero | 70 | 31 | 101 |
| 2023 Enero | 54 | 16 | 70 |
| 2022 Diciembre | 87 | 29 | 116 |
| 2022 Noviembre | 53 | 38 | 91 |
| 2022 Octubre | 62 | 30 | 92 |
| 2022 Septiembre | 63 | 39 | 102 |
| 2022 Agosto | 53 | 59 | 112 |
| 2022 Julio | 70 | 56 | 126 |
| 2022 Junio | 61 | 41 | 102 |
| 2022 Mayo | 64 | 37 | 101 |
| 2022 Abril | 86 | 47 | 133 |
| 2022 Marzo | 78 | 60 | 138 |
| 2022 Febrero | 109 | 18 | 127 |
| 2022 Enero | 92 | 28 | 120 |
| 2021 Diciembre | 85 | 55 | 140 |
| 2021 Noviembre | 71 | 40 | 111 |
| 2021 Octubre | 108 | 75 | 183 |
| 2021 Septiembre | 55 | 34 | 89 |
| 2021 Agosto | 102 | 43 | 145 |
| 2021 Julio | 59 | 42 | 101 |
| 2021 Abril | 22 | 4 | 26 |
| 2021 Marzo | 4 | 0 | 4 |
| 2020 Diciembre | 0 | 2 | 2 |
| 2020 Octubre | 1 | 0 | 1 |
| 2020 Septiembre | 0 | 2 | 2 |
| 2020 Julio | 12 | 22 | 34 |
| 2020 Junio | 42 | 28 | 70 |
| 2020 Mayo | 37 | 26 | 63 |
| 2020 Abril | 34 | 20 | 54 |
| 2020 Febrero | 0 | 2 | 2 |
| 2019 Septiembre | 3 | 1 | 4 |
Mostrar todo
