Resumen En pacientes con enfermedad pulmonar obstructiva crónica (EPOC), el trasplante pulmonar unilateral (SLT, por sus siglas en inglés) se realiza como alternativa a la disponibilidad limitada de donantes para el trasplante pulmonar bilateral. Sin embargo, el manejo postoperato rio del SLT presenta desafíos, incluyendo complicaciones relacionadas con la distinta complacencia de cada pul món. Este reporte presenta el caso de un paciente varón de 65 años que fue sometido a un SLT y se encontraba en el proceso de destete de la ventilación mecánica. Se administró terapia de oxígeno de alto flujo (HFOT, por sus siglas en inglés) y se midieron los efectos fisiológicos utilizando la tomografía de impedancia eléctrica (EIT, por sus siglas en inglés). Los resultados demostraron que la aplicación de HFOT aumentó la retención de aire y la hiperinflación en el pulmón nativo sin beneficiar al pulmón trasplantado. Tanto la HFOT a través de un tubo de traqueostomía como a través de cánula nasal resultaron en una distribución más heterogénea de la ventilación, con un aumento en la impedancia pulmonar al final de la espiración, prolongación de las constantes de tiempo espiratorias y un aumento en los espacios silentes. La disminución de la impedancia tidal después de aplicar HFOT no indicó hipoventilación, sino más bien hiperinsuflación y retención de gas en el pulmón nativo, mientras que el pulmón trasplantado mostró evidencia de hipoventilación. Estos hallazgos sugieren que el HFOT puede no ser beneficioso para los pacientes con SLT y podría empeorar los resultados. Sin embargo, debido al alcance limitado de este informe de caso, se necesitan estudios prospectivos con cohortes de pacientes más amplias para confirmar estos resultados.

Abstract In patients with chronic obstructive pulmonary dis ease (COPD), single lung transplantation (SLT) is some times performed as an alternative to bilateral lung trans plantation due to limited organ availability. However, the postoperative management of SLT presents challenges, including complications related to the distinct compli ance of each lung. This case report presents the case of a 65-year-old male patient who underwent SLT and was in the weaning period from mechanical ventilation. High-flow oxygen therapy (HFOT) was administered, and the physiological effects were measured using electrical impedance tomography (EIT). The results demonstrated that the application of HFOT increased air trapping and overdistention in the native lung without benefiting the transplanted lung. HFOT through a tracheostomy tube or nasal cannula resulted in a more heterogeneous distri bution of ventilation, with increased end expiratory lung impedance, prolonged expiratory time constants, and an increase in silent spaces. The drop in tidal impedance after applying HFOT did not indicate hypoventilation but rather overdistention and air trapping in the native lung, while the transplanted lung showed evidence of hypoventilation. These findings suggest that HFOT may not be beneficial for SLT patients and could potentially worsen outcomes. However, due to the limited scope of this case report, further prospective studies with larger patient cohorts are needed to confirm these results.

Abstract In Mexico, the legal recognition of same-sex marriage began twelve years ago in the country’s capital. Following this reform, same-sex marriage legislation has advanced and encountered different obstacles at the national level. This article examines the development and current state of public opinion regarding same-sex marriage in Mexico through theories based on modernization, generational change, political attitudes, and religion. In order to test our hypotheses, this research uses data from LAPOP surveys (2010-2018) in a series of regression models. Our findings indicate that higher educational levels, being younger and living in urban areas makes it more likely for individuals to support same-sex marriage. In contrast, those who are part of evangelical groups are more likely to disagree than Catholics or people without a religious affiliation. On average, there is a trend of growing support for same-sex marriage legislation in Mexico.

Resumen En México, el reconocimiento legal del matrimonio entre personas del mismo sexo comenzó en la capital del país hace doce años. Después de esta reforma, la legislación sobre el matrimonio igualitario ha avanzado y enfrentado distintos obstáculos a nivel nacional. Este artículo examina el desarrollo y estado actual de la opinión pública con respecto al matrimonio igualitario en México por medio de teorías basadas en la modernización, el cambio generacional, las actitudes políticas y la religión. Con el objetivo de poner a prueba nuestras hipótesis, esta investigación utiliza datos de LAPOP en sus distintos levantamientos (2010-2018) para realizar una serie de modelos de regresión lineal. Los hallazgos señalan que mayores niveles educativos, ser más joven y habitar en zonas urbanas aumenta la probabilidad de apoyar el matrimonio igualitario. Por el contrario, aquellas personas que forman parte de grupos evangélicos tienen mayor probabilidad de estar en desacuerdo que las personas sin religión o los católicos. En términos generales, se observa una tendencia de apoyo creciente por el matrimonio igualitario en México.

Abstract Background Postoperative Hyperlactatemia (PO-HL) is a frequent condition associated with poor prognosis. In recent years, there has been growing evidence that adrenergic stimulation may contribute to increased lactate levels. The use of adrenergic agonists for the control of intraoperative hypotension is frequent, and its impact on the development of PO-HL is unknown. Objective To evaluate whether the use of intraoperative adrenergic agents is associated with the occurrence of PO-HL. Methods This was a prospective observational study. The inclusion criteria were undergoing elective open colon surgery, being ≥60 years old and signing informed consent. The exclusion criteria were cognitive impairment, unplanned surgery, and anticipated need for postoperative mechanical ventilation. Baseline and intraoperative variables were collected, and arterial lactate data were collected at baseline and every 6 hours postoperatively for 24 hours. Hyperlactatemia was defined as lactate >2.1 mEq.L-1. Results We studied 28 patients, 61% of whom developed hyperlactatemia. The variables associated with PO-HL in the univariate analysis were anesthetic time, the total dose of intraoperative ephedrine, and lower intraoperative central venous oxygen saturation (ScvO2). Multivariate analysis confirmed the association between the use of ephedrine (p = 0.004), intraoperative hypotension (p = 0.026), and use of phenylephrine (p = 0.001) with PO-HL. Conclusions The use of intraoperative ephedrine, phenylephrine and intraoperative hypotension were independently associated with the development of PO-HL. This finding should lead to new studies in this field, as well as a judicious interpretation of the finding of a postoperative increase in lactate levels.

Abstract This article analyzes the populist activation of the electorate during the 2018 presidential election in Mexico, which requires a set of conditions. First, voters need to report grievances about the country’s political, economic, and social situation. Moreover, it is necessary the role of ambitious politicians to make those grievances salient among voters, in order for voters to be responsive to candidate’s populist rhetoric and translate their anger into electoral behavior. However, as opposed to previous studies, we argue that not every voter will be mobilized as a response to populist rhetoric, even if they register the same level of populist attitudes. Consistent with the political behavior literature, we argue that voters’ party identification constitutes a filter of information that makes co-partisan voters more likely to accept the populist rhetoric when it is consistent with their political predispositions. In other words, if the populist rhetoric contradicts voters’ partisanship, voters will reject the candidate’s populist rhetoric even though those voters report a high level of populist attitudes.

Resumen Este artículo estudia la activación populista del electorado en la elección presidencial de 2018 en México, la cual requiere una serie de condiciones. Por un lado, los votantes deben sentir un agravio sobre la situación política, económica o social en el país. Además, es necesaria la capacidad de políticos ambiciosos para hacer relevantes esos agravios entre el electorado y así los votantes respondan a la retórica populista para traducir su enojo en movilización electoral. Sin embargo, a diferencia de otros estudios, argumentamos que no todos los votantes son movilizados por igual como respuesta a la retórica populista, incluso si registran un nivel similar de actitudes populistas. De acuerdo con la literatura sobre comportamiento político, argumentamos que la identidad partidista de los votantes constituye un filtro de información que hace más probable que los electores acepten la retórica populista si es consistente con sus predisposiciones políticas. Por el contrario, si la retórica populista contradice su identidad partidista, los votantes rechazarán la retórica del candidato populista a pesar de que esos votantes registren un nivel alto de actitudes populistas.

Abstract: This research analyses the clientelistic outreach in the context of modern campaigns in new democracies like Mexico. We argue that Mexican parties intensely engage in clientelistic practices due to two combined factors: 1) electoral reforms that created incentives for parties to invest heavily on direct contact campaign strategies and 2) adaptation of modern campaigning (GOTV get-out-the-vote campaign operations) that enable them to maximize the distribution of electoral gifts as part of their political communication strategy. This type of clientelism is not distributed by traditional machine politics targeting the poor. Instead, parties in Mexico have adapted modern political campaigning creating an effective network of clientelistic outreach. The empirical evidence for this article comes from an original survey conducted during the 2012 presidential election and the 2015 National Electoral Study (CIDE-CSES).

Resumen: Este artículo analiza las estrategias clientelares partidistas en el contexto de la modernización de las campañas en democracias jóvenes como México. Argumentamos que los partidos en México usan estrategias clientelares intensamente debido a dos factores combinados: 1) reformas electorales que crearon incentivos para que los partidos puedan invertir mucho de su financiamiento público en estrategias de contacto directo y 2) la adaptación de estrategias modernas de contacto directo que les permiten maximizar la distribución de regalos electorales como parte integral de la comunicación política en las campañas. Este tipo de contacto clientelar no se distribuye principalmente por la tradicional maquinaria electoral partidista que focaliza sus esfuerzos en los electores de menor nivel socioeconómico. Los partidos en México han adaptado técnicas modernas de campaña para crear una red efectiva de alcance clientelar como parte integral de la comunicación política. La evidencia de este artículo se encuentra en una encuesta original levantada durante la elección presidencial de 2012 y en el Estudio Nacional Electoral 2015 (CIDE-CSES).

Abstract: From a praxeological position, conceptions about teaching and learning take an important role in the implementation of the prescribed curriculum and in the configuration of learning experiences in the classroom. The objective of this work is to identify and characterize conceptions about teaching and learning of the natural sciences in early childhood educators in training at the beginning of a course in the Didactics of Natural Sciences. The results indicate that there is a coexistence between positions close to models with traits having a strong, radical rationalism, and notions about the teaching and learning of traditional-dogmatic-type sciences with characteristics of a moderate rationalism and a constructivist notion with respect to learning.

Resumen: Desde un posicionamiento praxeológico, las concepciones sobre enseñanza y aprendizaje cobran un rol importante en la puesta en práctica del currículum prescrito y en la configuración de las experiencias de aprendizaje en el aula. Este trabajo tiene por objetivo identificar y caracterizar concepciones sobre enseñanza y aprendizaje de las ciencias naturales en Educadoras de Párvulos en formación al inicio de un curso de Didáctica de las Ciencias Naturales. Los resultados indican que existe una coexistencia entre posiciones cercanas a modelos con rasgos de un racionalismo fuerte, radical, y nociones sobre la enseñanza y el aprendizaje de las ciencias de tipo tradicional-dogmática con características de un racionalismo moderado y una noción constructivista respecto al aprendizaje.

Resumo Justificativa: O delírio pós-operatório é uma complicação séria em pacientes submetidos à cirurgia abdominal de grande porte. Ainda não está claro se as variáveis hemodinâmicas e de perfusão no período perioperatório afetam o risco de delírio pós-operatório. O objetivo deste estudo piloto foi avaliar a associação entre perfusão e hemodinâmica no perioperatório com o surgimento de delírio pós-operatório. Métodos: Estudo prospectivo de coorte de adultos com 60 anos ou mais, submetidos à cirurgia eletiva aberta do cólon. As variáveis multimodais de hemodinâmica e perfusão foram monitoradas, inclusive oxigenação venosa central (ScvO2), níveis de lactato e oxigenação cerebral não invasiva (rSO2), de acordo com um protocolo-padrão de anestesia. O teste exato de Fisher ou o teste t de Student foram usados para comparar os pacientes que desenvolveram delírio pós-operatório com aqueles que não desenvolveram p < 0,05. Resultados: Avaliamos 28 pacientes, 73 ± 7 anos, 60,7% do sexo feminino. Dois pacientes desenvolveram delírio pós-operatório (7,1%). Esses dois pacientes tinham menos anos de escolaridade do que aqueles sem delírio pós-operatório (p = 0,031). Nenhuma das variáveis de pressão arterial no perioperatório foi associada à incidência de delírio. Quanto aos parâmetros de perfusão, ScvO2 foi menor no grupo que apresentou delírio pós-operatório do que no grupo que não apresentou delírio, sem atingir significância estatística (65 ± 10% vs. 74 ± 5%; p = 0,08), mas o delta-ScvO2 (a diferença entre as médias no pós-operatório e intraoperatório) foi associado ao delírio (p = 0,043). As variáveis de lactato e rSO2 no pós-operatório não foram associadas ao delírio. Conclusões: Nosso estudo piloto sugere uma associação entre delta-ScvO2 e delírio e uma tendência à diminuição da ScvO2 no pós-operatório de pacientes com delírio. Estudos adicionais são necessários para elucidar essa associação.

Abstract Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p < 0.05). Results: We studied 28 patients, age 73 ± 7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p = 0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65 ± 10% vs. 74 ± 5%; p = 0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p = 0.043). Post-operative lactate and rSO2 variables were not associated with delirium. Conclusions: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.

We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.

Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress. He was managed with vasoactive drugs and prone positioning ventilation for 48 hours. Chest radiography showed a right superior lobe condensation. The electrocardiogram and echocardiogram suggested septic myocarditis. Blood cultures demonstrated the presence of serogroup W135-NM. A lumbar puncture ruled out meningitis, and a 10-day ceftriaxone therapy was completed favorably.

The study of the subjectivity and the subject appears today as a disputed field by different perspectives. In this article, we expose a framework to understand the subjectivity in a cultural historical approach and we propose theoretical, methodological and axiological issues for the study of subjectivity. We discuss the place of discourse in the study of social subjectivity through structuralism’s positions and proposals of social constructionism. Finally, we defend that the Critical Discourse Analysis proposed by Norman Fairclough as a solid theoretical-methodological perspective for the study of the complex links between subjectivity, discourse and social reality. We propose that this approach, based on categories such as discursive practice, social practice hegemony, discursive order, intertextuality and discursive shift, can address the theoretical, methodological and axiological challenges regarding the study of subjectivity.

El estudio de la subjetividad y del sujeto aparece en la actualidad como un campo en disputa por distintas corrientes y posiciones. Las propuestas para el estudio del campo de la subjetividad variarán de acuerdo a las concepciones teóricas y supuestos que sobre ella se tengan. En el presente artículo se plantean una serie de desafíos teóricos, metodológicos y axiológicos necesarios de afrontar para el estudio de la subjetividad. Asimismo, se discute el lugar del discurso en el estudio de la subjetividad social, debatiendo con las posiciones estructuralistas y con las propuestas del construccionismo social. Por otra parte, se expone una forma de comprender la subjetividad desde el enfoque histórico cultural y, en consistencia con lo anterior, se plantea una perspectiva teórica-metodológica pertinente para abordar las complejas relaciones entre subjetividad, discurso y realidad social: el Análisis Crítico del Discurso propuesto por Norman Fairclough. Proponemos que este enfoque, a partir de categorías como práctica discursiva, práctica social, hegemonía, orden discursivo, intertextualidad y cambio discursivo, permite abordar los desafíos teóricos, metodológicos y axiológicos antes planteados respecto del estudio de la subjetividad.

ABSTRACT Objective: To evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation. Methods: Between the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded. The efficacy of the procedure was evaluated according to an execution success rate and based on the necessity of switching to an open surgical technique. Safety was evaluated according to post-operative and operative complication rates. Results: The mean age of the group was 64 ± 18 years (203 women and 309 males). The mean APACHE II score was 21 ± 3. Patients remained an average of 11 ± 3 days on mechanical ventilation before percutaneous tracheostomy was performed. All procedures were successfully completed without the need to switch to an open surgical technique. Eighteen patients (3.5%) presented procedure complications. Five patients experienced transient desaturation, 4 presented low blood pressure related to sedation, and 9 presented minor bleeding, but none required a transfusion. No serious complications or deaths associated with the procedure were recorded. Eleven patients (2.1%) presented post-operative complications. Seven presented minor and transitory bleeding of the percutaneous tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2 developed a superficial infection of the stoma. Conclusion: Percutaneous tracheostomy using the single-step dilation technique with fiber optic bronchoscopy assistance seems to be effective and safe in critically ill patients under mechanical ventilation when performed by experienced intensive care specialists using a standardized procedure.

RESUMEN Objetivo: Evaluar eficacia y seguridad de la traqueostomía percutánea, mediante dilatación única con asistencia fibrobroncoscópica, en pacientes críticos sometidos a ventilación mecánica. Métodos: Entre los años 2004 y 2014, se incluyeron prospectivamente 512 enfermos consecutivos con indicación de traqueostomía según los criterios clínicos de nuestro centro. Un tercio de los pacientes fueron de alto riesgo. Se registraron variables demográficas, puntaje APACHE II, y días de ventilación mecánica previo a traqueostomía percutánea. La eficacia del procedimiento fue evaluada mediante tasa de éxito en su ejecución y necesidad de conversión a técnica abierta. La seguridad fue evaluada por tasa de complicaciones operatorias y postoperatorias. Resultados: La edad media del grupo fue 64 ± 18 años (203 mujeres y 309 varones). El puntaje APACHE II fue 21 ± 3. Los pacientes permanecieron en promedio 11 ± 3 días en ventilación mecánica antes de la realización de la traqueostomía percutánea. Todos los procedimientos se completaron exitosamente, sin necesidad de convertir a técnica abierta. Dieciocho pacientes (3,5%) presentaron complicaciones operatorias. Cinco pacientes experimentaron desaturación transitoria, cuatro presentaron hipotensión relacionada a la sedación, y nueve presentaron sangrado menor, pero ninguno requirió transfusión. No se registraron complicaciones graves, ni muertes asociadas al procedimiento. Once pacientes (2,1%) presentaron complicaciones postoperatorias. Siete presentaron sangrado menor y transitorio del estoma de la traqueostomía percutánea, 2 sufrieron desplazamiento de la cánula de traqueostomía y 2 desarrollaron infección superficial del estoma. Conclusión: La traqueostomía percutánea mediante la técnica de dilatación única con asistencia fibrobroncoscópica, parece ser efectiva y segura en enfermos críticos sometidos a ventilación mecánica, cuando es realizada por intensivistas experimentados mediante un abordaje estandarizado.

Actually, we participate in a depth debate about educational reform that includes a new policy of teaching career. This debate is unprecedented by the questioning of the student movement from 2006 onwards. In this context, this paper reports on a documentary analysis of the requirements for the work of teachers as set out in the statutory bodies that were generated after the student’s movilizations of 2006 that questioned the legitimacy of the Chilean education system. These statutory bodies that make up what we call the new regulatory framework of Chilean education. The main findings points in four ways: to a standardization of the objectives of teaching, through intensive measurement; an incipient process standardization teaching jobs; an improvement in the accountability mechanisms, through external inspections and promoting client relationship with families; and, finally, the establishment of new mechanisms of flexibility job, through the loss of profesional exclusivity and new forms of contract. Finally, it is pointed out how this new legal framework, even in implementation, is not considering the educational community and also is generating control logic on the teachers’s job.

En la actualidad, asistimos a un profundo debate en torno a una reforma educativa que contempla una nueva política de carrera docente. Este debate encuentra precedentes en el cuestionamiento del movimiento estudiantil desde 2006 en adelante. En este marco, la presente investigación da cuenta de un análisis de contenido categorial de las prescripciones sobre la labor de los/as docentes que cuestionaron la legitimidad del sistema educativo chileno establecidas en los cuerpos legales generados con posterioridad a las movilizaciones estudiantiles del año 2006. Estos cuerpos legales componen lo que hemos denominado el nuevo marco regulatorio de la educación escolar chilena. Los principales hallazgos apuntan en cuatro direcciones: una estandarización de los objetivos del trabajo docente, a través de la medición intensiva, una incipiente estandarización de los procesos de trabajo docente; un perfeccionamiento de los mecanismos de accountability, a través de inspecciones externas y de la promoción de una relación clientelar con las familias; y, finalmente el establecimiento de nuevos mecanismos de flexibilización laboral, a través de la pérdida de la exclusividad profesional y de nuevas formas de contrato flexible.

Recent research on teacher labor has pinpointed the importance of improving our understanding of the meanings attributed to work. This article presents the main findings of a qualitative research on teacher' attributions of work and the affective experience of work, in teachers working in hospital classrooms of Santiago, Chile. The results from focus group analysis show two main groups of meanings of work: facilitating students' reintegration into the formal school, and experiencing classroom relationships as a normal space. Regarding the experience of the affective dimensions of work, we found four nuclei of meaning: validation of emotions, oscillating and extreme experiences, intensity of the established emotional ties and valuing the affective aspects of work as a privilege. We discuss these results in the light of evidence from recent research on teaching work in Chile.

Investigaciones recientes sobre trabajo docente han relevado la importancia de conocer mejor los sentidos atribuidos al trabajo. Este artículo presenta los principales hallazgos de una investigación cualitativa sobre sentidos atribuidos al trabajo y vivencia de las dimensiones afectivas del mismo, por educadoras de aulas hospitalarias de Santiago, Chile. Los resultados encontrados en el análisis de grupos focales dan cuenta dos núcleos centrales de significados sobre los sentidos del trabajo: facilitar la reinserción del estudiante a la escuela formal y vivir las relaciones de aula como un espacio de normalidad. Respecto a la vivencia de las dimensiones afectivas del trabajo se encontraron cuatro núcleos de significado: la validación de las emociones, su vivencia extrema y oscilante, la intensidad de los vínculos afectivos establecidos y la valoración de los aspectos afectivos del trabajo como un privilegio. Finalmente, discutimos estos resultados a la luz de evidencias de investigaciones recientes sobre trabajo docente en Chile.

Relatamos o tratamento bem-sucedido de dois pacientes com hemorragia subaracnóidea complicada com grave falência respiratória e choque séptico refratário, utilizando, simultaneamente, ventilação em posição prona e hemofiltração de alto volume. Esses tratamentos de resgate permitiram que os pacientes superassem a grave situação sem complicações associadas ou efeitos deletérios na pressão intracraniana e de perfusão cerebral. A ventilação em posição prona é, hoje, um tratamento aceito para síndrome de desconforto respiratório agudo grave, e a hemofiltração de alto volume é um suporte hemodinâmico não convencional, que tem diversos mecanismos potenciais para melhorar o choque séptico. Neste artigo revisamos brevemente esses tratamentos e as evidências relacionadas. Quando outras terapias convencionais são insuficientes para proporcionar oxigenação e perfusão como parte do cuidado neuroprotetor básico dentro de limites seguros em pacientes com hemorragia subaracnóidea, esses tratamentos de resgate podem ser considerados caso a caso por uma equipe com experiência em cuidados críticos.

We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team.