Una escala para la predicción de la lesión pulmonar aguda

REMI envía todos sus contenidos gratuitamente por correo electrónico a más de 9.200 suscriptores. [Suscripción]. ¡Visita REMI en FACEBOOK!

Artículo nº 1612. Vol 11 nº 3,  marzo 2011.
Autor: Ramón Díaz-Alersi

---

Una escala para la predicción de la lesión pulmonar aguda

Artículo original: Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, Anderson H, 3rd, Hoth JJ, Mikkelsen ME, Gentile NT, Gong MN, Talmor D, Bajwa E, Watkins TR, Festic E, Yilmaz M, Iscimen R, Kaufman DA, Esper AM, Sadikot R, Douglas I, Sevransky J. Am J Respir Crit Care Med 2011; 183(4): 462-470. [Resumen] [Artículos relacionados]

Introducción: Es complicado pronosticar qué pacientes pueden desarrollar una lesión pulmonar aguda (LPA). Este síndrome rara vez está presente en el momento de la presentación del paciente en Urgencias, y un reciente estudio [1] demuestra que la gran mayoría de los pacientes con factores de riesgo nunca llegan a desarrollar una LPA. Esto hace complicado tanto el desarrollo de medidas preventivas como el diseño de estudios clínicos para su prevención o tratamiento precoz. El objetivo de este estudio es determinar la frecuencia y el pronóstico del desarrollo de la LPA en pacientes en riesgo y validar una escala de predisposición (Lung Injury Prediction Score, LIPS).

Resumen: Estudio de cohortes desarrollado en 22 hospitales, con un total a 5.584 pacientes consecutivos con uno o más de los factores de riesgo definidos previamente (entre otros: sepsis, shock, pancreatitis, neumonía, aspiración, inhalación de humo, traumatismo de alto riesgo, cirugía de alto riesgo). Se excluyeron los pacientes con LPA en el momento de la valoración. La discriminación del modelo se determinó mediante el área bajo la curva y el riesgo de muerte debida a LPA (desenlace secundario) se determinó tras ajustar para la gravedad (APACHE II) y las condiciones predisponentes. La LPA se desarrolló en el 6,8% de los pacientes tras una mediana de 2 días (rango intercuartil 1-4). La frecuencia de la LPA varió según los factores predisponentes desde un 3% para la pancreatitis a un 26% para la inhalación de humo. La LIPS discriminó a los pacientes que desarrollaron LPA (área bajo la curva 0,80; IC 95% 0,78-0,82). La LPA aumentó el riesgo de muerte (OR 4,1; IC 95% 2,9-5,7).

Comentario: Se trata de una escala fácil de valorar cuya principal ventaja es su elevado valor predictivo negativo (con más de 4 puntos: 0,97), permitiendo descartar a pacientes cuyo riesgo de LPA es muy bajo. Su valor predictivo positivo es bastante más modesto, pero al detectar a los pacientes en riesgo muy precozmente, permite al menos instaurar medidas protectoras de bajo coste, principalmente protegiendo a los pacientes de la exposición a nuevos factores de riesgo (transfusiones, ventilación con volúmenes elevados, aspiración, amiodarona, etc.). Otra limitación del estudio es que, al exigir al menos un factor de riesgo en los pacientes para su inclusión, pueden haberse dejado fuera pacientes que desarrollaron factores de riesgo tras la primera valoración.

Ramón Díaz-Alersi
Hospital U. Puerto Real, Cádiz
©REMI, http://remi.uninet.edu. Marzo 2011.

Tabla I. Cálculo de la puntuación LIPS

Factores de riesgo (puntos)

• Shock (2)
• Aspiración (2)
• Sepsis (1)
• Neumonía (1,5)
• Cirugía ortopédica espinal (1)
• Cirugía de abdomen agudo (2)
• Cirugía cardiaca (2.5)
• Cirugía aórtica vascular (3,5)
• TCE (2)
• Inhalación de humo (2)
• Casi ahogamiento (2)
• Contusión pulmonar (1,5)
• Múltiples fracturas (1,5)

Factores modificadores (puntos)

• Etilismo crónico (1)
• Obesidad [BMI > 30] (1)
• Hipoalbuminemia (1)
•  Quimioterapia (1)
•  FIO2 > 0,35 o > 4 L/min (2)
• Taquipnea > 30 (1,5)
• SpO2 < 95% (1)
• Acidosis [pH < 7,35] (1,5)
• Diabetes mellitus (-1)

(con más de 4 puntos: valor predictivo negativo 0,97; sensibilidad 0,69; especificidad 0,78)

Enlaces:

1. Clinical risk conditions for acute lung injury in the intensive care unit and hospital ward: a prospective observational study. Ferguson ND, Frutos-Vivar F, Esteban A, Gordo F, Honrubia T, Peñuelas O, Algora A, García G, Bustos A, Rodríguez I. Crit Care 2007; 11(5): R96. [PubMed] [Texto completo] [REMI]

Búsqueda en PubMed:

• Enunciado: Estudios sobre factores de riesgo de la lesion pulmonar aguda
• Sintaxis: acute lung injury AND risk factor
• [Resultados]

Palabras clave: Lesión pulmonar aguda, Escala predictiva.

Cuál es la mejor estrategia para el tratamiento de la obesidad en niños?

Cuál es la mejor estrategia para el tratamiento de la obesidad en niños?

Ensayo clínico multicéntrico, aleatorizado y controlado sobre un programa de actividad física para niños, un programa de modificación de la dieta dirigido a padres, o la combinación de ambos en niños con sobrepeso: estudio HIKCUPS

Artículo original:

Multi-site randomized controlled trial of a child-centered physical activity program, a parent-centered dietary-modification program, or both in overweight children: the HIKCUPS study

Autores: Okely AD, Collins CE, Morgan PJ y colaboradores.

Revista: Journal of Pediatrics 2010; 157(3): 388-94.

Puede descargarlo en el siguiente link:

http://www.box.net/shared/i5iby4cqqe

El Caparazón

The Khan academy o el probable futuro de la educación Posted: 18 Mar 2011 09:23 AM PDT Muchos/as pensamos que para cambiar el mundo es necesario empezar por la educación. También Salman Khan, el fundador de la Khan Academy, que ha subido miles de videos a YouTube para enseñar matemáticas y otras materias en formato audiovisual, proponiendo una metodología de aprendizaje enteramente nueva, la defendía durante la última edición de las Ted conferences 2011 en EEUU.  Su academia, con cientos de miles de visitas diarias y más de un millón de usuarios habituales está siendo valorada incluso como complemento o mejora de la educación formal. En este aspecto los argumentos son rotundos: si podemos explicar los conceptos teóricos mediante vídeo, un formato que por otro lado es más familiar para los niños/as, podremos ocupar el tiempo que los niños/as pasan en la institución en cosas tan importantes en el momento actual como la atención personalizada, el diálogo, la educación de la participación o la construcción colaborativa. El formato vídeo tiene varias ventajas, entre las que figura la posibilidad de adaptar el aprendizaje al ritmo del estudiante o la posibilidad de practicar sin la presencia de profesores o compañeros/as de clase. Trabajar con Youtube permite, además de mayor difusión, generar engagement mediante el diálogo, crear comunidades alrededor de sus canales. Por cierto,  hace tiempo que no visito Illasaron pero creo que Jesús Conde y sus videotutoriales pueden ser considerado en infórmática uno de los precursores de los métodos de Salman. Aparecen, además de la consabida importancia de lo social, varias de las idea que presentábamos recientemente en Expoelearning 2011 (Claves y competencias para el aprendizaje en la era web): -La Googleización en positivo del aprendizaje: Aplicando algoritmos de análisis de los datos que recoge de los alumnos, la plataforma puede planificar su progreso. Además, los profesores proveen feedback para refinar los resultados automáticos. -”Do it yourself”, el alumno debe adoptar un papel proactivo, ir como decíamos de la educación al aprendizaje para aprovechar el potencial de la Academia Khan. -Salman propone los mapas, las rutas  de conocimiento, una idea similar a la de Curación (“depuración”, podría ser un término alternativo, como comentaba un asistente a la exposición de Madrid) de contenidos que definíamos. -La idea de juego, de adaptación de la maestría en motivación de los creadores de videojuegos a premiar los avances en aprendizaje. Badges, puntos, etc. pretenden motivar el aprendizaje mediante la diversión. Por último, resulta interesante la visión de Khan acerca del poder de democratización de la tecnología, “el aula global” a la que alumnos de todo el mundo podrán acceder algún día.  Aplicaciones que tienden a la diversidad de los niños/as autistas, variantes lingüísticas y geográficas, son varias ya las compañías que siguen las ideas y aplican la metodología de la Khan academy al desarrollo de variados nuevos sistemas. ¿Construir mejores futuros para la educación y el mundo en general? Sí, podremos

En este día...

ON THIS DAY

March 19

• See larger version »
• Buy a reproduction »

On March 19, 1920, the United States Senate rejected for the second time the Treaty of Versailles by a vote of 49-35, falling short of the two-thirds majority needed for approval.
Go to article »

On March 19, 1891, Earl Warren, the chief justice of the U.S. Supreme Court from 1953 to 1969, was born. Following his death on July 9, 1974, his obituary appeared in The Times.

Go to obituary » | Other birthdays »

On This Date

1860	William Jennings Bryan, secretary of state and three-time Democratic presidential nominee, was born in Salem, Ill.
1891	Earl Warren, the 14th chief justice of the United States, was born in Los Angeles.
1917	The Supreme Court upheld the eight-hour work day for railroads.
1918	Congress approved daylight-saving time.
1920	The U.S. Senate rejected the Treaty of Versailles for a second time.
1931	Nevada legalized gambling.
1945	Adolf Hitler issued his so-called "Nero Decree" ordering the destruction of German facilities that could fall into Allied hands.
1953	The Academy Awards ceremony was televised for the first time.
1962	Bob Dylan's self-titled debut album was released.
1979	The U.S. House of Representatives began televising its day-to-day business.
1987	Televangelist Jim Bakker resigned as chairman of his PTL ministry organization amid a sex-and-money scandal involving a former church secretary, Jessica Hahn.
1988	Two British soldiers were shot to death after they were dragged from a car and beaten by mourners attending an Irish Republican Army funeral in Belfast, Northern Ireland.
1990	Latvia's political opposition claimed victory in the republic's first free elections in 50 years.
1995	After giving up an attempt to become a major league baseball player, Michael Jodan returned to pro basketball with his former team, the Chicago Bulls.
2001	California officials declared a power alert, ordering the first of two days of rolling blackouts.
2003	Mahmoud Abbas accepted the new position of Palestinian prime minister.
2008	Science fiction writer Arthur C. Clarke died at age 90.
2009	An Austrian jury sentenced a man to life in a psychiatric ward for locking his daughter in a dungeon for 24 years, fathering her seven children and letting one die in captivity as a newborn.

Current Birthdays

Actress Glenn Close ("Damages," "Fatal Attraction") turns 64 years old today.

AP Photo/Gus Ruelas

Philadelphia Eagles head coach Andy Reid turns 53 years old today.

AP Photo/Barbara Johnston

1925	Brent Scowcroft, Former national security adviser, turns 86
1930	Ornette Coleman, Jazz saxophonist, turns 81
1933	Philip Roth, Author, turns 78
1936	Ursula Andress, Actress, turns 75
1946	Ruth Pointer, Singer (The Pointer Sisters), turns 65
1952	Harvey Weinstein, Movie producer, turns 59
1955	Bruce Willis, Actor, turns 56

Historic Birthdays

Earl Warren3/19/1891 - 7/9/197414th chief justice of the United States (1953-69).Go to obituary »

56	Johannes Magnus 3/19/1488 - 3/22/1544 Swedish Roman Catholic archbishop and historian
66	Alonso Cano 3/19/1601 - 9/3/1667 Spanish painter, sculptor and architect
81	Elias Hicks 3/19/1748 - 2/27/1830 American Quaker minister; advocated the abolition of slavery
42	Nikolay Gogol 3/19/1809 (OS) - 2/21/1852 (OS) Ukrainian-born Russian humorist, dramatist and novelist
60	David Livingstone 3/19/1813 - 5/1/1873 Scottish missionary and explorer; opened Africa to the West
69	Sir Richard Burton 3/19/1821 - 10/20/1890 English scholar, explorer, writer and translator
80	Wyatt Earp 3/19/1848 - 1/13/1929 American frontiersman; became lawman and gambler
80	Alfred von Tirpitz 3/19/1849 - 3/6/1930 German admiral and chief builder of German navy before World War I
65	William Jennings Bryan 3/19/1860 - 7/26/1925 American Democratic and Populist leader
100	James Van Fleet 3/19/1892 - 9/23/1992 American commander who led troops in Normandy on D-Day in World War II
58	Frederic Joliot-Curie 3/19/1900 - 8/14/1958 French Nobel Prize-winning physicist; shared prize with his wife, Irene
74	Jo Mielziner 3/19/1901 - 3/15/1976 American stage designer
88	John Sirica 3/19/1904 - 8/14/1992 United States district court judge; presided at trial of Watergate burglars (1973)
76	Albert Speer 3/19/1905 - 9/1/1981 German Nazi minister for war production
56	Adolf Eichmann 3/19/1906 - 5/31/1962 German Nazi war criminal hanged by Israel

PRACTICAL TRAVELER

Saving Money on a Trip to Asia

By MICHELLE HIGGINS

Published: March 16, 2011

• RECOMMEND
• TWITTER
• COMMENTS (4)
• SIGN IN TO E-MAIL
• PRINT
• SINGLE PAGE
• REPRINTS
• SHARE

PLANNING a trip to Asia this year? Better get booking.

Enlarge This Image

Victo Ngai

Readers' Comments

Share your thoughts.

• Post a Comment »
• Read All Comments (4) »

International tourist arrivals to the region increased 11 percent in 2010, according to the Pacific Asia Travel Association. And tour operators that cater to United States travelers say bookings this year are already well ahead of last year.

“Our most popular 14-day tour of China already has more passengers booked to travel in 2011 than the entire 2010 season,” Marty Seslow, vice president for sales and marketing at Gate 1 Travel, based in Fort Washington, Pa., said a few weeks ago.

That means bargains will be harder to come by for travelers who are only now planning vacations. Rising jet fuel costs aren’t helping matters. And stronger Asian currencies, from the Taiwan dollar (up about 8 percent against the dollar compared with a year ago, according toTravelex, a currency exchange company) to the Malaysian ringgit (up roughly 11 percent), means Americans have less buying power. (One exception is Vietnam — where United States travelers are getting about 12 percent more for the dollar than a year ago.) But it’s still possible to save on your Asian vacation if you plan carefully.

Getting There

One of the biggest expenses of any trip to Asia, whether a whirlwind tour of China or a beach holiday in Bali, is simply getting there. During high season, flights from the United States can cost $1,600 or more round trip, and that’s in coach. Discounts, offered sporadically, aren’t as deep as they were a few years ago. George Hobica, founder ofAirfarewatchdog.com, which scours the Web for airfare bargains, noted a recent discount — flights to Korea and Japan on American Airlines for $700 round trip, including tax. “In past years, we saw fares for half that amount,” he said. His advice: “Sign up for frequent flier programs, and airline e-mails, even if you won’t really be doing it for the miles.” Asian airlines often reserve their best fares for their own Web sites, he said, noting that Singapore Airlines recently slashed fares by $300 to $400 on more than two dozen routes — a sale it disclosed first to AirfareWatchdog and via e-mail to its frequent flier members.

If you have a stockpile of frequent flier miles on an airline that doesn’t fly to your Asian destination, you still may be able to use those miles, thanks to airline alliances. For example, American Airlines does not fly to Hong Kong, but Cathay Pacific, a OneWorld alliance member, which has a code-share agreement with American Airlines, does and accepts American miles.

Jetting Around Asia

Once in Asia, use budget airlines like AirAsia or Tiger Airways to jet around. “They have ridiculously low fares,” said Stephanie Trzaska, an American expatriate who has been living in Asia for the last four years, including in Tokyo, Hong Kong and Singapore. She recently paid $226 total for round-trip flights on Tiger Airways from Singapore to Kuala Lumpur, Malaysia, for herself; her husband, Will Karlin; and their 1-year-old-daughter, Lena. The same flight on a mainstream airline, she said, would have been at least double that amount.

She added that Zuji.com, Travelocity’s Singapore-based affiliate, can be helpful when searching for budget carriers. But be sure to check the airline site directly before you book in case the fare is lower on the carrier’s site.

Many Asia-bound travelers have several destinations on their itineraries. If you fall into this category, consider an air pass. Cathay Pacific, OneWorld, SkyTeam and Star Alliance are among the airlines and alliances that offer passes, which allow travelers to fly to multiple cities within a country or region, often for hundreds of dollars less than if you bought individual tickets. But read the fine print since the tickets often come with booking restrictions and hefty change fees.

One with fewer restrictions, said Simone Farbus, air travel manager at Asia Transpacific Journeys, is the Discover Asia Airpass, operated by SilkAir, a subsidiary of Singapore Airlines, which offers flights between 22 Asian destinations, ranging from $145 to $345 per segment. “There are no minimum or maximum restrictions on the amount of coupons or segments, and there’s also no minimum stay requirement,” she said. “We also like the fact that if circumstances change and the client has to cancel or change their ticket it will only cost $25.” One drawback: because the air pass uses Singapore as a hub, travelers who want to fly to, say, Siem Reap in Cambodia from Yangon, in Myanmar, must first fly to Singapore. But that additional flight can shave a lot off your costs. A trip in late April along that route starts at $980 when using the air pass, versus $2,885 if booked as individual tickets, Ms. Farbus said.

One air pass that doesn’t require backtracking is the Discovery Airpass, operated in a joint venture by Bangkok Airways, Lao Airlines and Berjaya Air, with flights between Thailand, Cambodia and Laos and many of the small island resorts in the region. Flights between countries are typically $120 per segment, according to Ms. Farbus, and domestic flights range from $65 to $113.

Readers' Comments

Share your thoughts.

• Post a Comment »
• Read All Comments (4) »

Hotels

Agoda.com, which was purchased by Priceline in 2007, is a good place to begin your search. It offers deals at more than 10,000 hotels in the Asia-Pacific sphere, including specially negotiated last-minute rates that can offer savings. For example, a “family” room, which comes with a double and a single bed, at the Yeng Keng Hotel, a 20-room boutique hotel in the City of George Town in Penang, Malaysia, was offered for $118 in mid-March on Agoda versus the promotional rate of 380 ringgit, or about $125, listed on the hotel’s own site.

You can also bid for hotels in major Asian cities on Priceline.com.hk, choosing trip dates, hotel star rating and the general neighborhood you wish to stay in, and then naming your own price — just as you do on the United States site but this time in Hong Kong dollars. As on Priceline’s United States hotel site, you learn the name of the hotel after you pay.

Packages that combine air and hotel are another way to save. For example, Singapore Airlines Vacations’ Amazing 5 Nights Bali Package offers five nights at the Nusa Dua Beach Hotel, round-trip flights from Los Angeles for two, airport transfers and daily breakfast for $3,028, including taxes, in early May. If booked separately, five nights at the Nusa Dua Beach Hotel ($640) and the airfare for two ($3,068) came to $3,708 for the same trip.

You’ll get the best rates in the off-season, of course, but there are tradeoffs. You can have the Forbidden City practically to yourself in Beijing in December, but you’ll have to bundle up, with daytime temperatures hovering around freezing.

The so-called shoulder season offers something of a sweet spot for travelers looking for deals. For example, the 10-day Taste of China Tour offered by Friendly Planet Travel based in Jenkintown, Pa., costs $1,649 during peak summer season. But travelers who go in April, when the weather is milder, pay $1,399. “All the components for the various prices are the same,” said Peggy Goldman, president of Friendly Planet Travel. “The only thing that changes is the departure date.”