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"tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "618" "paginaFinal" => "619" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hering-Breuer reflex and non-invasive mechanical ventilation. Does it also occur during expiration?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1679 "Ancho" => 2667 "Tamanyo" => 564754 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Captura de pantalla durante la adaptación de la ventilación. A) Puede observarse la deflexión mencionada en el texto (flecha), y B)</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Su desaparición con la programación de una rampa de desaceleración de 250<span class="elsevierStyleHsp" style=""></span>ms.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marina Galdeano, Manel Luján" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Marina" "apellidos" => "Galdeano" ] 1 => array:2 [ "nombre" => "Manel" "apellidos" => "Luján" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212916302257" "doi" => "10.1016/j.arbr.2016.05.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916302257?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616301259?idApp=UINPBA00003Z" "url" => "/03002896/0000005200000012/v1_201611260110/S0300289616301259/v1_201611260110/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212916302233" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.04.014" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1380" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2016;52:619-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4683 "formatos" => array:3 [ "EPUB" => 166 "HTML" => 3866 "PDF" => 651 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "NUT Midline Carcinoma of the Lung, A Rare Form of Lung Cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "619" "paginaFinal" => "621" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma NUT pulmonar, una forma poco frecuente de cáncer de pulmón" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1350 "Ancho" => 1800 "Tamanyo" => 430772 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography images showing the pulmonary lesion in the right upper lobe, and images from the pathological examination showing undifferentiated tumor cells (A) and positive immunoreaction to NUT antibody (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Benito Bernáldez, Concepción Romero Muñoz, Virginia Almadana Pacheco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Benito Bernáldez" ] 1 => array:2 [ "nombre" => "Concepción" "apellidos" => "Romero Muñoz" ] 2 => array:2 [ "nombre" => "Virginia" "apellidos" => "Almadana Pacheco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616301016" "doi" => "10.1016/j.arbres.2016.04.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616301016?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916302233?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000012/v1_201611260059/S1579212916302233/v1_201611260059/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212916302269" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.05.017" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1387" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2016;52:617-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2079 "formatos" => array:3 [ "EPUB" => 127 "HTML" => 1427 "PDF" => 525 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Alpha-1 Antitrypsin Deficiency Associated With the Mmalton Variant. 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Descripción de una familia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Marco Figueira Gonçalves, Francisco Martínez Bugallo, David Díaz Pérez, María Dolores Martín Martínez, Ignacio García-Talavera" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Juan Marco" "apellidos" => "Figueira Gonçalves" ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "Martínez Bugallo" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Díaz Pérez" ] 3 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Martín Martínez" ] 4 => array:2 [ "nombre" => "Ignacio" "apellidos" => "García-Talavera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616301260" "doi" => "10.1016/j.arbres.2016.05.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616301260?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916302269?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000012/v1_201611260059/S1579212916302269/v1_201611260059/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Hering-Breuer Reflex and Non-invasive Mechanical Ventilation. Does it Also Occur During Expiration?" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "618" "paginaFinal" => "619" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marina Galdeano, Manel Luján" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Marina" "apellidos" => "Galdeano" "email" => array:1 [ 0 => "marinagaldeano@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Manel" "apellidos" => "Luján" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unitat de Cures Respiratòries Intermèdies, Servei de Pneumologia, Hospital Universitàri Sagrat Cor, Univeristat de Barelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servei de Pneumologia, Hospital de Sabadell, Corporació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER de Enfermedades Respiratorias (CIBERES), Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reflejo de Hering-Breuer y ventilación mecánica no invasiva ¿también durante la espiración?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1008 "Ancho" => 1602 "Tamanyo" => 291886 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Screenshot obtained during ventilation adaptation. (A) The deflection mentioned in the text can be observed (arrow) and (B) resolution after setting a deceleration ramp of 250<span class="elsevierStyleHsp" style=""></span>ms.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Interpreting and evaluating the importance of patient-ventilator asynchronies in non-invasive mechanical ventilation (NIMV) is an extremely difficult task. Some of the experiences published in the literature suggest that some asynchronies detected in clinical practice are directly induced by the ventilator, as muscles respond to mechanical stimuli. For example, the phenomenon known as “reverse triggering”<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> has been described in profoundly sedated adult patients receiving invasive ventilation and may be a new form of diaphragmatic neuromechanical coupling, induced by a reflex mediated by adaptation of the stretch receptors during inspiration (Hering-Breuer reflex). This phenomenon has only been described in sedated patients receiving invasive ventilation, and to date no cases of muscle response to mechanical stimuli have been described in patients receiving NIMV.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 62-year-old woman with amyotrophic lateral sclerosis, with predominant upper neuron involvement and significant hyperreflexia. NIMV was indicated due to forced vital capacity below 50% predicted value, mild hypercapnia (PaCO<span class="elsevierStyleInf">2</span> 46<span class="elsevierStyleHsp" style=""></span>mmHg) and incipient intolerance to a decubitus position. Titration began with a nasal interface and chinstrap for periods of 1–2<span class="elsevierStyleHsp" style=""></span>h on consecutive days with a Lumis<span class="elsevierStyleSup">®</span> 150 pressure ventilator (ResMed, North Ryde, Australia). Parameters at the end of the first session were: IPAP 18<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O, EPAP 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O, rise time 150<span class="elsevierStyleHsp" style=""></span>ms, Timin 0.6<span class="elsevierStyleHsp" style=""></span>s and Timax 1.5<span class="elsevierStyleHsp" style=""></span>s, triggering and cycling settings at mean values. Unintentional leak was maintained at acceptable values after a chinstrap was placed (less than 10<span class="elsevierStyleHsp" style=""></span>l/min overall), and breathing rate was around 18–20<span class="elsevierStyleHsp" style=""></span>bpm. During real time monitoring of pressure-time and flow-time curves, deflection was observed at the start of flow-time waveform expiration, despite good initial tolerance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Since deflection occurred at the start of expiration, with persistent exertion during this phase (premature cycling asynchrony<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a>), the cycling setting was modified, prolonging rise time to 250<span class="elsevierStyleHsp" style=""></span>ms (in order to delay maximum flow, and thus, cycling), and Timin of 0.8 was superimposed, but the abnormality persisted. Finally, while previous rise time values were maintained without superimposing the time criterion, the deceleration ramp was modified from inspiration to expiration, and was set at 250<span class="elsevierStyleHsp" style=""></span>ms, with subsequent resolution of the disorder (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The abnormality could be resolved only by modifying the descent time in this patient with marked hyperreflexia, suggesting that the visible alteration in flow–time curves might be due to an automatic response of the patient's respiratory system. This is similar to the situation described by Akoumianaki et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> although these authors described the phenomenon in patients receiving sedation and relaxation. Instead of being a chest expansion reflex, the response appears to be associated more with a deflation reflex that remains relatively constant from cycle to cycle.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Not all ventilator models record deceleration. To date, its use in clinical practice has not been reported in the literature, although, theoretically at least, it should improve tolerance to the sudden flow inversion that occurs during the transition from inspiration to expiration. Most of the time this flow inversion, that may be as high as 80<span class="elsevierStyleHsp" style=""></span>lx′ [although in our patient it was around 60<span class="elsevierStyleHsp" style=""></span>lx′ (20–40<span class="elsevierStyleHsp" style=""></span>lx′)] does not produce any symptoms, but some patients might report discomfort. In our patient, the flow inversion appeared to trigger an automatic respiratory response, intensified by concomitant generalized hyperreflexia. Amyotrophic lateral sclerosis may present in different forms, not only in terms of muscle topography, but also in the degree of spasticity and hyperreflexia. Thus, predominant lower motor neuron involvement produces weakness and atrophy, while upper motor neuron involvement produces basically spastic hypertonia and hyperreflexia that can affect any muscle group. Reflecting findings made first in animal models and later in patients,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> our patient's diaphragm may have been activated due to deflation in the presence of vagal nerve integrity. This anomaly can also be observed on spirometry in forced expiratory maneuvers, when cough is induced by maximum expiration (Fontana reflex).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, patient-ventilator asynchrony observed in our patient does not appear to be the same as cases previously described in the literature, since it does not meet the characteristics of premature cycling (it is not modified by prolonging inspiratory time or cycling settings) or reverse triggering (the cycle before the asynchrony is not controlled). For this reason, diaphragmatic activation during transition to expiration may be a plausible interpretation that would explain the persistence of asynchrony and improvement with progressive depressurization.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Galdeano M, Luján M. Reflejo de Hering-Breuer y ventilación mecánica no invasiva ¿también durante la espiración? Arch Bronconeumol. 2016;52:618–619.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1008 "Ancho" => 1602 "Tamanyo" => 291886 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Screenshot obtained during ventilation adaptation. (A) The deflection mentioned in the text can be observed (arrow) and (B) resolution after setting a deceleration ramp of 250<span class="elsevierStyleHsp" style=""></span>ms.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical ventilation-induced reverse-triggered breaths: a frequently unrecognized form of neuromechanical coupling" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Akoumianaki" 1 => "A. Lyazidi" 2 => "N. Rey" 3 => "D. Matamis" 4 => "N. Pérez-Martínez" 5 => "R. 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Widdicombe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-0262" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2011" "volumen" => "140" "paginaInicial" => "586" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21896518" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000012/v1_201611260059/S1579212916302257/v1_201611260059/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000012/v1_201611260059/S1579212916302257/v1_201611260059/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916302257?idApp=UINPBA00003Z" ]
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2022 March | 87 | 38 | 125 |
2022 February | 83 | 31 | 114 |
2022 January | 84 | 40 | 124 |
2021 December | 58 | 32 | 90 |
2021 November | 51 | 42 | 93 |
2021 October | 55 | 44 | 99 |
2021 September | 62 | 42 | 104 |
2021 August | 59 | 42 | 101 |
2021 July | 93 | 31 | 124 |
2021 June | 79 | 27 | 106 |
2021 May | 54 | 45 | 99 |
2021 April | 126 | 91 | 217 |
2021 March | 79 | 23 | 102 |
2021 February | 70 | 22 | 92 |
2021 January | 66 | 18 | 84 |
2020 December | 66 | 27 | 93 |
2020 November | 148 | 15 | 163 |
2020 October | 96 | 24 | 120 |
2020 September | 33 | 14 | 47 |
2020 August | 52 | 16 | 68 |
2020 July | 35 | 29 | 64 |
2020 June | 52 | 13 | 65 |
2020 May | 43 | 13 | 56 |
2020 April | 40 | 17 | 57 |
2020 March | 38 | 11 | 49 |
2020 February | 52 | 19 | 71 |
2020 January | 56 | 16 | 72 |
2019 December | 65 | 23 | 88 |
2019 November | 104 | 26 | 130 |
2019 October | 40 | 17 | 57 |
2019 September | 59 | 13 | 72 |
2019 August | 41 | 20 | 61 |
2019 July | 29 | 10 | 39 |
2019 June | 41 | 11 | 52 |
2019 May | 68 | 17 | 85 |
2019 April | 70 | 39 | 109 |
2019 March | 54 | 23 | 77 |
2019 February | 54 | 24 | 78 |
2019 January | 35 | 20 | 55 |
2018 December | 37 | 10 | 47 |
2018 November | 58 | 33 | 91 |
2018 October | 61 | 27 | 88 |
2018 September | 44 | 11 | 55 |
2018 May | 17 | 1 | 18 |
2018 April | 28 | 6 | 34 |
2018 March | 36 | 6 | 42 |
2018 February | 38 | 7 | 45 |
2018 January | 88 | 10 | 98 |
2017 December | 62 | 7 | 69 |
2017 November | 47 | 10 | 57 |
2017 October | 15 | 9 | 24 |
2017 September | 20 | 5 | 25 |
2017 August | 12 | 10 | 22 |
2017 July | 25 | 8 | 33 |
2017 June | 29 | 12 | 41 |
2017 May | 31 | 18 | 49 |
2017 April | 32 | 31 | 63 |
2017 March | 17 | 12 | 29 |
2016 December | 2 | 0 | 2 |