Última modificación: 2019-08-31
Resumen
Organophosphorus compounds are esters of phosphoric acid that are mainly used as pesticides for agricultural-pest or as chemical weapons. Acute organophosphate poisoning remains a major health problem related to careless manipulation, self-poisoning, and chemical warfare. In Colombia, large-scale pesticide poisoning in the last 50 years involved at least 1000 persons with a mortality near to 10 % [1]. The management of toxicity is difficult for medical personnel due to the lack of knowledge about the evolution of the poisoning and the low percentage of therapeutic efficiency used, which leads to patients to require long and expensive recovery periods in an intensive care unit. Medical treatment as used at present is an iterative process between application of doses of drug and medical monitoring [2].
In the current thesis, a new index and an extended cardiorespiratory model considering the respiratory muscle activity was proposed to improve the determining of the appropriate timing for initiating extubation maneuvers in patients intoxicated with organophosphorus compounds. This thesis opens the possibility of exploring and using surface electromyography as complementary information to determine the best moment to suspend ventilatory support for understanding the cardiorespiratory response in these patients. The results showed a high correlation between the pattern of the respiratory muscles and the patient's response during the spontaneous breathing test, associating the level of engagement with the muscular weakness in poisoned patients. According to the experimental data and optimization results, this muscular response is correlated with the sympathetic and parasympathetic balance measured through the heart rate variability. This information is very important in diagnosis of health and disease states. Having more knowledge about the balance of these systems allows evaluating the efficiency of pharmacological treatment, given the clinical condition of the intoxicated patient.
The results found open the possibility of having a tool that decreases the iterative process in both therapy and training. It will be a strategy to understand the interaction of respiratory and cardiac systems during intoxication and can be used to help in decision making in other patients undergoing mechanical ventilation.