Dolor neuropático / Neurophatic pain

Enero 2, 2018. No. 2951

Una revisión del manejo del dolor del miembro fantasma: desafíos y soluciones. A review of the management of phantom limb pain: challenges and solutions. Richardson C1, Kulkarni J2. Author information J Pain Res. 2017 Aug 7;10:1861-1870. doi: 10.2147/JPR.S124664. eCollection 2017. Abstract BACKGROUND: Phantom limb pain (PLP) occurs in 50% and 80% of amputees. Although it is often classified as a neuropathic pain, few of the large-scale trials of treatments for neuropathic pain included sufficient numbers of PLP sufferers to have confidence that they are effective in this condition. Many therapies have been administered to amputees with PLP over the years; however, as of yet, there appears to be no first-line treatment. OBJECTIVES: To comprehensively review the literature on treatment modalities for PLP and to identify the challenges currently faced by clinicians dealing with this pain. METHOD: MEDLINE, EMBASE, CINAHL, British Nursing Index, Cochrane and psycINFO databases were searched using "Phantom limb" initially as a MeSH term to identify treatments that had been tried. Then, a secondary search combining phantom limb with each treatment was performed to find papers specific to each therapy. Each paper was assessed for its research strength using the GRADE system. RESULTS: Thirty-eight therapies were identified. Overall, the quality of evidence was low. There was one high-quality study which used repetitive transcutaneous magnetic stimulation and found a statistical reduction in pain at day 15 but no difference at day 30. Significant results from single studies of moderate level quality were available for gabapentin, ketamine and morphine; however, there was a risk of bias in these papers. Mirror therapy and associated techniques were assessed through two systematic reviews, which conclude that there is insufficient evidence to support their use. CONCLUSION: No decisions can be made for the first-line management of PLP, as the level of evidence is too low. Robust studies on homogeneous populations, an understanding of what amputees consider a meaningful reduction in PLP and agreement of whether painintensity is the legitimate therapeutic target are urgently required. KEYWORDS: pain; phantom limb pain; review; treatment PDF La ketamina en el tratamiento del dolor crónico según medicina basada en la evidencia F. Neira Reina y J. L. Ortega García Rev. Soc. Esp. Dolor vol.23 no.6 Madrid nov./dic. 2016  RESUMEN La ketamina es un antagonista no competitivo de los receptores NMDA y tiene un amplio mecanismo de acción que involucra, además, a los receptores AMPA, kainato, ácido gamma-aminobutírico, opioides, monoaminérgicos, muscarínicos y nicotínicos. Actúa sobre los canales de calcio y sodio voltaje-dependientes, interviene en la síntesis y liberación del óxido nítrico e inhibe la recaptación de serotonina. La interacción con todos estos mecanismos de acción hace que tenga una importante participación sobre mecanismos del dolor, inflamación, neuroprotección y tolerancia de opioides.  En este trabajo se revisan las diferentes vías de administración de la ketamina, su dosificación, las modalidades de administración, la duración del tratamiento, las indicaciones según los niveles de evidencia disponibles y los efectos secundarios; para establecer su eficacia en la terapéutica del dolor crónico y promover un tratamiento más específico, en aquellas patologías en las que se ha demostrado una mayor eficacia. Se realizó una búsqueda en Trip Database Population Intervention Comparison Outcome (PICO), National Guidelines Clearinghouse, Cochrane Library, Medline, CMA infobase, Health Services/Technology Assessment, New Zealand Guidelines Group y Scottish Intercollegiate Guidelines Network. La ketamina tiene una gran versatilidad en cuanto a sus vías de administración (intravenosa, intramuscular, subcutánea, sublingual, oral, rectal, nasal, transdérmica, epidural y subaracnoidea), así como modalidades de administración (bolos, infusión continua). No obstante, la vía oral es la más utilizada y preferida para el tratamiento del dolor crónico. Sin embargo, no disponemos de una formulación oral comercializada, lo que dificulta su utilización. El empleo clínico de la ketamina requiere una cuidadosa selección del paciente y valoración de la relación riesgo/beneficio. Se debe tener presente los antecedentes de abuso de drogas ante el riesgo potencial de abuso del fármaco.  Se dispone de evidencia sobre la eficacia de la ketamina en pacientes con dolor oncológico refractario y en el síndrome doloroso regional complejo (SDRC). Hay evidencia moderada sobre la eficacia de la ketamina intravenosa a dosis bajas, en el SDRC, que no justifica su utilización sistemática en este síndrome. En el dolor neuropático, la ketamina se ha mostrado especialmente eficaz en el control de la alodinia, hiperalgesia e hiperpatía, pero existen controversias sobre su utilización. La ketamina oral puede tener un lugar en el tratamiento del dolor crónico de los pacientes refractarios a tratamientos habituales. Se ha mostrado útil como coadyuvante de otros analgésicos, especialmente en pacientes en tratamiento con opioides, permitiendo disminuir la dosis e incrementando el control analgésico de los pacientes con dolor crónico. Palabras clave: Ketamina, dolor crónico, dolor neuropático, síndrome doloroso regional complejo. PDF Manejo del dolor crónico neuropático con metadona combinada con ketamina: un ensayo clínico aleatorizado, doble ciego, con control activo. Management of Neuropathic Chronic Pain with Methadone Combined with Ketamine: A Randomized, Double Blind, Active-Controlled Clinical Trial. Rigo FK1, Trevisan G2, Godoy MC3, Rossato MF4, Dalmolin GD5, Silva MA6, Menezes MS3, Caumo W7, Ferreira J5. Author information Pain Physician. 2017 Mar;20(3):207-215. Abstract BACKGROUND: Methadone and ketamine are used in neuropathic pain management. However, the benefits of both drugs association are uncertain in the treatment of neuropathic pain. OBJECTIVE: Our primary objective was test the hypothesis that oral methadone combined with oral ketamine is more effective than oral methadone or ketamine alone in reducing neuropathic pain. STUDY DESIGN: We conducted a randomized, double blind, active-controlled parallel-group clinical trial. METHODS: Forty-two patients with neuropathic pain refractory to conventional therapy were randomly assigned to receive oral methadone (n = 14), ketamine (n = 14), or methadone plus ketamine (n = 14) over a 3-month period. RESULTS: During these 90 days, we observed pain scores using a visual analogical scale (VAS), allodynia, burning/shooting pain, and some side effects. All treatments were effective in reducing pain scores by at least 40%. However, a significant improvement in pain was observed only in the ketamine alone group compared with both the methadone or methadone/ketamine groups. No significant differences were observed among the treatment groups for the reduction of burning or shooting pain, while ketamine alone was more effective than methadone or methadone/ketamine for the reduction of allodynia. LIMITATIONS: Formal assessment for awareness of the allocation was not performed, some co-intervention bias may have occurred, our results could be only relevant to the patient population investigated and the use of VAS as the primary outcome detect changes in pain intensity but not to assess neuropathic pain symptoms. CONCLUSION: This study indicates that ketamine was better than methadone or methadone/ketamine for treating neuropathic pain.Key words: Multimodal analgesia, refractory pain, NMDA receptor, opioid. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Anestesia general y desarrollo cerebral en niños / General anesthesia and pediatric brain development

Enero 3, 2018. No. 2952

La anestesia general de larga duración influye en la inteligencia de los niños en edad escolar. Long-duration general anesthesia influences the intelligence of school age children. Zhang Q1, Peng Y1, Wang Y2. Author information BMC Anesthesiol. 2017 Dec 19;17(1):170. doi: 10.1186/s12871-017-0462-8. Abstract BACKGROUND: General anesthesia has been linked to impaired brain development in immature animals and young children. In this study the influence of orthopedic surgery under general anesthesia on the intelligence of school age children has been evaluated.  CONCLUSIONS: More than 3 h general anesthesia influenced the IQ of school age children for up to 3 months after orthopedic surgery. Beside extended exposure time to anesthetics additional factors for post-operative IQ reduction were younger children age, mothers with low educational levels and premature birth. TRIAL REGISTRATION: Chinese Clinical Trial Registry with registration number ChiCTR-OOC-17013497  retrospectively registered on 11/23/2017. KEYWORDS: Children; Cognition; General anesthesia; Intelligence; Orthopedic surgery PDF Efectos de la anestesia en el cerebro en desarrollo. Infantes y fetos Effect of Anesthesia on the Developing Brain: Infant and Fetus. Andropoulos DB1. Author information Fetal Diagn Ther. 2017 Jun 7. doi: 10.1159/000475928. [Epub ahead of print] Abstract The potential for commonly used anesthetics and sedatives to cause neuroapoptosis and other neurodegenerative changes in the developing mammalian brain has become evident in animal studies over the past 15 years. This concern has led to a number of retrospective studies in human infants and young children, and some of these studies observed an association between exposure to general anesthesia as an infant, and later neurobehavioral problems in childhood. This association is particularly evident for prolonged or repeated exposures. Because of the significant growth of fetal interventions requiring sedation and analgesia for the fetus, or because of maternal anesthetic effects, this concern about anesthetic neurotoxicity is relevant for the fetus. The potential for anesthetic neurotoxicity is the most important clinical and research problem in the field of pediatric anesthesiology. This review will first briefly summarize the rapid brain growth and development in the fetus and neonate. Next, animal model data of anesthetic neurotoxicity in the fetus and neonate will be presented, followed by a review of recent human clinical anesthetic neurotoxicity trials. Finally, the rationale for studying dexmedetomidine as a potential neuroprotectant agent in anesthetic neurotoxicity will be reviewed along with study design for two human clinical trials involving dexmedetomidine. KEYWORDS: Anesthetic neurotoxicity; Dexmedetomidine; Fetus; Isoflurane; Neonate; Sevoflurane PDF Efectos de la anestesia sobre el desarrollo cerebral de los niños Effects of Anesthesia on Children's Brain Development Hernández-Cortez Enrique J Anesth Crit Care Open Access 2015, 2(6): 00079 Summary Nowadays, the administration of most of the anesthetics is being questioned. The quality of reversibility of these medications is being questioned, especially when administered to children under 3 years old. The administration of isoflurane elevates intracellular calcium levels which are critical for cell damage resulting in apoptosis. The NMDA and GABA receptors are indirectly involved in the effect of immature brains. The immaturity of the central nervous system associated to the administration of anesthetic agents such as inhaled anesthetics, ketamine, midazolam, nitrous oxide, and others, produces important changes in the brain that have an impact in the child's later life. There are two important elements in the neurotoxicity of anesthetics, dosage and time administration. Repeating anesthetics produces more brain changes. These modifications have resulted in serious behavioral and memory changes in experiments in animals. It is suspected that a similar situation may arise in children who manifest learning disabilities in later stages.  Keywords: Apoptosis; Anesthetics; Children PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Reconstrucción del complejo posterolateral de la rodilla

http://www.clinicadeartroscopia.com.mx/academia/reconstruccion-del-complejo-posterolateral-de-la-rodilla/


Reconstrucción del complejo posterolateral de la rodilla con técnica de Laprade más exploración neurológica del nervio ciático poplíteo externo con epineurólisis feliz Año Nuevo 2018 !! 🎉🎊del cirujano Dr. Hinojosa de lesiones complejas de rodilla



Reconstruction of the posterolateral complex of the knee with Laprade technique plus neurological exploration of the external popliteal sciatic nerve with epineurolysis happy New Year 2018 !! 🎉🎊from Dr. Hinojosa surgeon of complex knee injuries

El efecto del inserto humeral constriñido de polietileno en la biomecánica de la artroplastia de hombro reversa

http://www.lesionesdeportivas.com.mx/academia/el-efecto-del-inserto-humeral-constrinido-de-polietileno-en-la-biomecanica-de-la-artroplastia-de-hombro-reversa/



By admin in academia

The effect of humeral polyethylene insert constraint on reverse shoulder arthroplasty biomechanics.



Fuente

Este artículo es originalmente publicado en:


https://www.ncbi.nlm.nih.gov/pubmed/29276534
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734524/
http://journals.sagepub.com/doi/10.1177/1758573217701065



De:


Abdulla I1, Langohr DG1, Giles JW1, Johnson JA1, Athwal GS1.
Shoulder Elbow. 2018 Jan;10(1):25-31. doi: 10.1177/1758573217701065. Epub 2017 Apr 5.





Abstract

Background:

There is little information on the effects of altering reverse shoulder arthroplasty (RSA) polyethylene constraint on joint load, load angle and deltoid force. The present biomechanical study aimed to investigate the effects of changing RSA polyethylene constraint on joint load, load angle, deltoid force and range of motion.


Conclusions:

Altering polyethylene cup constraint in RSA to enhance stability does not significantly alter resultant joint loads and deltoid forces. Surprisingly, terminal abduction range of motion was also not significantly different with varying cup constraint, indicating that terminal impingement may be tuberosity related rather than polyethylene.

KEYWORDS:

complication; constraint; instability; polyethylene; reverse total shoulder arthroplasty; rotator cuff tear arthropathy




Resumen


Antecedentes:

Hay poca información sobre los efectos de la alteración de la restricción de polietileno de la artroplastia de hombro inversa (RSA) en la carga articular, el ángulo de carga y la fuerza del deltoides. El presente estudio biomecánico tuvo como objetivo investigar los efectos del cambio de la restricción de polietileno RSA sobre la carga articular, el ángulo de carga, la fuerza deltoide y el rango de movimiento.


Conclusiones

La alteración de la restricción de la copa de polietileno en el RSA para mejorar la estabilidad no altera significativamente las cargas conjuntas resultantes y las fuerzas deltoides. Sorprendentemente, el rango de movimiento de abducción terminal tampoco fue significativamente diferente con la restricción variable de la copa, lo que indica que la incidencia del terminal puede estar relacionada con la tuberosidad en lugar del polietileno.


PALABRAS CLAVE:

complicación; restricción; inestabilidad; polietileno; artroplastia total de hombro invertida; artropatía del desgarro del manguito de los rotadores


PMID: 29276534 PMCID: PMC5734524 [Available on 2019-01-01]DOI: 10.1177/1758573217701065

Factores asociados con la pobre elevación anterior activa después de la artroplastia total de hombro reversa

http://www.lesionesdeportivas.com.mx/academia/factores-asociados-con-la-pobre-elevacion-anterior-activa-despues-de-la-artroplastia-total-de-hombro-reversa/


By admin in academia

Factors associated with poor active anterior elevation after reverse total shoulder arthroplasty


Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/29275846
http://www.jshoulderelbow.org/article/S1058-2746(17)30687-0/fulltext



De:


Jeon YS1, Rhee YG2.
J Shoulder Elbow Surg. 2017 Dec 21. pii: S1058-2746(17)30687-0. doi: 10.1016/j.jse.2017.10.027. [Epub ahead of print]



Todos los derechos reservados para:


Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.



Abstract

BACKGROUND:

Although reverse total shoulder arthroplasty (RTSA) has been shown to reduce pain and to improve function in most patients, some still suffer from functional limitations. This study aimed to investigate the incidence of poor motion recovery after RTSA and to identify factors that may cause poor outcomes.


CONCLUSION:

Satisfactory improvement of active anterior elevation was achieved in three-quarters of patients who underwent RTSA using a prosthesis designed to be medialized. Of the factors we investigated, only postoperative LHO was found to be a significant risk factor for poor postoperative active anterior elevation. Therefore, surgeons should attempt to avoid increasing postoperative LHO when performing RTSA using an implant designed to be medialized.



KEYWORDS:

Shoulder; lateral humeral offset; medialized prosthesis; poor anterior elevation; reverse total shoulder arthroplasty; risk factors














Resumen


ANTECEDENTES:

Aunque la artroplastia total de hombro invertida (RTSA) ha demostrado reducir el dolor y mejorar la función en la mayoría de los pacientes, algunos todavía sufren limitaciones funcionales. Este estudio tuvo como objetivo investigar la incidencia de la recuperación de movimiento pobre después de RTSA e identificar los factores que pueden causar resultados pobres.




CONCLUSIÓN:

Se logró una mejora satisfactoria de la elevación anterior activa en tres cuartas partes de los pacientes sometidos a RTSA utilizando una prótesis diseñada para medializar.De los factores que investigamos, solo el LHO postoperatorio se encontró como un factor de riesgo significativo para la elevación anterior activa posoperatoria deficiente.Por lo tanto, los cirujanos deben intentar evitar el aumento de la LHO postoperatoria cuando realicen RTSA usando un implante diseñado para ser medializado.




PALABRAS CLAVE:

Hombro; desplazamiento lateral del húmero; prótesis medializada; mala elevación anterior; artroplastia total de hombro reversa; factores de riesgo

PMID: 29275846 DOI: 10.1016/j.jse.2017.10.027



Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Regresar a los deportes después de la artroplastia de hombro reversa: la perspectiva suiza

http://www.lesionesdeportivas.com.mx/academia/regresar-a-los-deportes-despues-de-la-artroplastia-de-hombro-reversa-la-perspectiva-suiza/


Return to sports after reverse shoulder arthroplasty-the Swiss perspective


Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29273836
https://link.springer.com/article/10.1007%2Fs00264-017-3715-8



De:

Kolling C1,2, Borovac M3,4, Audigé L5,3, Mueller AM4, Schwyzer HK5.
Int Orthop. 2017 Dec 22. doi: 10.1007/s00264-017-3715-8. [Epub ahead of print]



Todos los derechos reservados para:


Copyright information
© SICOT aisbl 2017


Abstract

PURPOSE:

This patient survey evaluated the return to previous sports activities in Swiss patients up to five years after reverse shoulder arthroplasty (RSA).
CONCLUSIONS:

Returning to previous sports activities is an important expectation of RSA patients, and the majority do. Patient expectations of post-operative sports activity need to be addressed when planning RSA.

KEYWORDS:

Patient expectations; Reverse shoulder arthroplasty; Sports; Survey




Resumen
PROPÓSITO:

Esta encuesta de pacientes evaluó el regreso a actividades deportivas previas en pacientes suizos hasta cinco años después de la artroplastia de hombro invertida (RSA).


CONCLUSIONES:

Volver a las actividades deportivas anteriores es una expectativa importante de los pacientes RSA, y la mayoría lo hace. Las expectativas del paciente de la actividad deportiva postoperatoria deben abordarse al planificar RSA.


PALABRAS CLAVE:

Expectativas del paciente; Artroplastia de hombro reversa; Deportes; Encuesta
PMID: 29273836 DOI: 10.1007/s00264-017-3715-8

Evaluación de la posición de la glenosfera: abordaje superior versus deltopectoral para artroplastia reversa de hombro

http://www.lesionesdeportivas.com.mx/academia/evaluacion-de-la-posicion-de-la-glenosfera-abordaje-superior-versus-deltopectoral-para-artroplastia-reversa-de-hombro/


By admin in academia


Assessing glenosphere position: superior approach versus deltopectoral for reverse shoulder arthroplasty


Fuente:

Este artículo es originalmente publicado en:
https://www.ncbi.nlm.nih.gov/pubmed/29273388
http://www.jshoulderelbow.org/article/S1058-2746(17)30673-0/fulltext



De:
Aibinder WR1, Clark NJ1, Schoch BS2, Steinmann SP3.
J Shoulder Elbow Surg. 2017 Dec 19. pii: S1058-2746(17)30673-0. doi: 10.1016/j.jse.2017.10.013. [Epub ahead of print]



Todos los derechos reservados para:


Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.



Abstract

BACKGROUND:

The anterosuperior (AS) approach for reverse total shoulder arthroplasty (RTSA) has been reported as a risk factor for baseplate malposition because of potential difficulty in glenoid exposure. The objective of this study was to compare glenoid baseplate position between the AS and deltopectoral (DP) approaches in relation to the surgeon’s experience and to evaluate the effect of placement on clinical outcomes.


DISCUSSION AND CONCLUSION:

Both approaches produce similar baseplate position, clinical outcomes, and rates of scapular notching when they are used for RTSA. Attempts to inferiorize the glenoid baseplate through the AS approach may increase the risk of superior inclination.



KEYWORDS:

Shoulder arthroplasty; cuff tear arthropathy; deltopectoral; malposition; notching; reverse; superior approach


Resumen
ANTECEDENTES:

El abordaje anterosuperior (AS) para la artroplastia total de hombro reversa (RTSA) se ha informado como un factor de riesgo para la mala posición de la placa base debido a la posible dificultad en la exposición glenoidea. El objetivo de este estudio fue comparar la posición de la placa base glenoidea entre los abordajes AS y deltopectoral (DP) en relación con la experiencia del cirujano y evaluar el efecto de la colocación en los resultados clínicos.


DISCUSIÓN Y CONCLUSIÓN:

Ambos abordajes producen una posición similar de la placa de base, resultados clínicos y tasas de muescas escapulares cuando se usan para RTSA. Los intentos de inferiorizar la placa base glenoidea a través del abordaje AS pueden aumentar el riesgo de una inclinación superior.

PALABRAS CLAVE:
Artroplastia de hombro; artropatía por desgarro del manguito; deltopectoral; malposición; muesca; reversa; abordaje superior

PMID: 29273388 DOI: 10.1016/j.jse.2017.10.013 Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

SIRA / ARDS

Diciembre 21, 2017. No. 2939

Conceptos actuales de síndrome de dificultad respiratoria aguda: una revisión narrativa Current Concepts of ARDS: A Narrative Review. Umbrello M1, Formenti P2, Bolgiaghi L3, Chiumello D4,5. Author information Int J Mol Sci. 2016 Dec 29;18(1). pii: E64. doi: 10.3390/ijms18010064. Abstract Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account. KEYWORDS: acute respiratory distress syndrome; critically ill patients; lung-protective ventilation; positive end-expiratory pressure PDF Manejo del síndrome de dificultad respiratoria aguda con posición prona Treatment of ARDS With Prone Positioning. Scholten EL1, Beitler JR2, Prisk GK3, Malhotra A2. Author information Chest. 2017 Jan;151(1):215-224. doi: 10.1016/j.chest.2016.06.032. Epub 2016 Jul 8. Abstract Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning. By optimizing patient selection and treatment protocols, the recent Proning Severe ARDS Patients (PROSEVA) trial demonstrated a significant mortality benefit with prone ventilation. This trial, and subsequent meta-analyses, support the role of prone positioning as an effective therapy to reduce mortality in severe ARDS, particularly when applied early with other lung-protective strategies. This review discusses the physiological principles, clinical evidence, and practical application of prone ventilation in ARDS. KEYWORDS: ARDS; critical care; hypoxemia; lung injury; ventilation PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org