El síndrome de dificultad respiratoria aguda incluye una compleja serie de acontecimientos que conducen a daño alveolar, edema pulmonar por aumento de la permeabilidad vascular e insuficiencia respiratoria; muchos procesos están relacionados con su aparición, la característica común es la activación de los neutrófilos en la circulación pulmonar o sistémica. Las manifestaciones clínicas aparecen generalmente 6 a 72 horas posterior al inicio del evento y empeoran rápidamente. El tratamiento se basa en un manejo interdisciplinario por parte del personal de la unidad de cuidados intensivos, se debe realizar un reconocimiento precoz de los pacientes descartando otras causas de hipoxemia, identificar y tratar la causa subyacente, y emplear la ventilación mecánica para asegurar correcta oxigenación, intentando siempre proteger los pulmones de la lesión pulmonar inducida por la técnica. La ventilación en decúbito prono favorece el aumento de la oxigenación en pacientes con este síndrome, los mecanismos que producen este incremento son probablemente múltiples e interdependientes y no han sido dilucidados en su totalidad. Es un procedimiento de bajo costo, recomendado implementar en pacientes categoría grave, y preferentemente en etapa tempana de la enfermedad, aunque es necesario realizar estudios futuros que puedan establecer el verdadero impacto en la mortalidad para evaluar su uso sistemático en todos los pacientes con Síndrome de Dificultad Respiratoria Aguda. MÉD.UIS. 2016;29(2):81-101.

The Acute Respiratory Distress Syndrome involves a complex series of events leading to alveolar damage, pulmonary edema due to increased vascular permeability and respiratory failure; many processes are related to its appearance, the common feature is the activation of neutrophils in the pulmonary or systemic circulation. Clinical manifestations usually appear 6 to 72 hours after the event start the event and get worse quickly. The treatment is based on an interdisciplinary handling by the staff of the intensive care unit, making an early recognition of patients ruling out other causes of hypoxemia, identifying and treating the underlying cause, and using mechanical ventilation to ensure proper oxygenation and ventilation, always trying to protect the lungs from mechanical ventilation induced lung injury. Prone position ventilation promotes increased oxygenation in patients with this syndrome, the mechanisms that cause this increase are probably multiple and interdependent and have not been fully elucidated. It is a low-cost procedure, recommended in patient in serious category, and preferably in early stage of the disease. Future studies are needed that can establish the real impact on mortality to assess their systematic use in all patients with Acute Respiratory Distiess Syndrome. MÉD.UIS. 2016;29(2):81-101.

Introduction: This work was carried out on the purpose of identifying the species of phlebotomine sandflies in the municipality of Monte Negro, state of Rondonia, Brazil, that may have been transmitting the American cutaneous leishmaniasis (ACL), and concisely describe epidemiological aspects of disease. METHODS: The epidemiologic and socioeconomical indicators were obtained from government institutions and the local Municipal Secretary of Health. Phlebotomine sandflies were captured using CDC light traps between July 2006 to July 2008. The total of 1,240 of female sandflies were examined by PCR method directed to k-DNA. RESULTS: There has been a significant decrease in the incidence of ACL of about 50% over the last ten years in the municipality. A total of 1,935 specimens of 53 sandfly species were captured, three of the genus Brumptomyia genus and 50 of the genus Lutzomyia. The predominant species was Lutzomyia acanthopharynx, Lutzomyia whitmani, Lutzomyia geniculata and Lutzomyia davisi. None were positive for Leishmania sp. CONCLUSIONS: Four sandflies species were found in the State of Rondonia for the first time: Brumptomyia brumpti, Lutzomyia tarapacaensis, Lutzomyia melloi and Lutzomyia lenti. The presence of Lutzomyia longipalpis, was also captured. Socioeconomical improvement of Brazilian economy and the increase of environmental surveillance in the last 15 years collaborated in the decrease of people exposed to vectors, reducing the incidence of ACL.