Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo

Autores:
Hernández Santacruz, Helen Katherine
Laverde Moreno, Camila
Soler Torres, Alfredo
Alejo de Paula, Luz Angela
Tipo de recurso:
Article of journal
Fecha de publicación:
2016
Institución:
Corporación Universitaria Iberoamericana
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Repositorio Ibero
Idioma:
spa
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oai:repositorio.ibero.edu.co:001/4448
Acceso en línea:
https://repositorio.ibero.edu.co/handle/001/4448
https://doi.org/10.33881/2011-7191.%x
Palabra clave:
Entrenamiento de músculos respiratorios
Unidad de cuidado intensivo
Fuerza de resistencia
Ventilación mecánica
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openAccess
License
http://purl.org/coar/access_right/c_abf2
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network_name_str Repositorio Ibero
repository_id_str
dc.title.spa.fl_str_mv Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
title Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
spellingShingle Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
Entrenamiento de músculos respiratorios
Unidad de cuidado intensivo
Fuerza de resistencia
Ventilación mecánica
title_short Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
title_full Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
title_fullStr Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
title_full_unstemmed Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
title_sort Intervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivo
dc.creator.fl_str_mv Hernández Santacruz, Helen Katherine
Laverde Moreno, Camila
Soler Torres, Alfredo
Alejo de Paula, Luz Angela
dc.contributor.author.spa.fl_str_mv Hernández Santacruz, Helen Katherine
Laverde Moreno, Camila
Soler Torres, Alfredo
Alejo de Paula, Luz Angela
dc.subject.spa.fl_str_mv Entrenamiento de músculos respiratorios
Unidad de cuidado intensivo
Fuerza de resistencia
Ventilación mecánica
topic Entrenamiento de músculos respiratorios
Unidad de cuidado intensivo
Fuerza de resistencia
Ventilación mecánica
publishDate 2016
dc.date.accessioned.none.fl_str_mv 2016-06-13 00:00:00
2022-06-14T21:52:07Z
dc.date.available.none.fl_str_mv 2016-06-13 00:00:00
2022-06-14T21:52:07Z
dc.date.issued.none.fl_str_mv 2016-06-13
dc.type.spa.fl_str_mv Artículo de revista
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dc.relation.citationedition.spa.fl_str_mv Núm. 2 , Año 2015 : Revista Movimiento Científico
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dc.relation.references.spa.fl_str_mv Acosta, T. B., Díaz, P. A., Alonso, O. V., Lara, A. J., Bueno, Y. L., & Hernández, S. (2005). Entrenamiento de los músculos respiratorios. (Spanish). Revista Cubana De Medicina Militar, 34(1), 1-5.
Aldrich, T. K., Karpel, J. P., Uhrlass, R. M., Sparapani, M. A., Eramo, D., & Ferranti, R. (1989). Weaning from mechanical ventilation: adjunctive use of inspiratory muscle resistive training. Critical care medicine, 17: 143-147.
Belman, M. J. (1981). Respiratory failure treated by ventilatory muscle training (VMT). A report of two cases. European Journal of respiratory diseases, 62(6): 391-395.
Bisset, B., Leditschke, I. A., Paratz, J. D., & Boots, R. J (2012). Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial. BMJ Open, 2(2). Disponible en: http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3293141/pdf/bmjopen-2012-000813.pdf
Bissett, B., Leditschke, I. A., Paratz, J. D., & Boots, R. J. (2012). Respiratory dysfunction in ventilated patients: Can inspiratory muscle training help? Anaesth Intensive Care, 40: 236-246.
Boles, J. M., Bion, J., Connors, A., Herridge , M., Marsh, B., Melot, C., . . . Welte, T. (2007). Weaning from Mechanical Ventilation. The european Respiratory Journal, 29(5): 1033-1056.
Bonnevie, T., Villiot- Danger, J. C., Gravier, F. E., Dupuis, J., Prieur, G., & Médrinal, C. (2015). Inspiratory muscle training is used in some intensive care units, but many training methods have uncertain efficacy: a survey of French physiotherapists. Journal of Physiotherapy, 61(4): 180-186.
Bourdin , G., Barbier, J., Burle, J. F., Durante, G., Passant, S., Vincent, B., . . . Guérin, C. (2010). The feasibility of early physical activity in intensive care unit patient: a prospective observational one-center study. Respiratory Care, 55(4):400-407.
Bravo-Acosta, T., Alonso-Díaz, P. L., del Valle-Alonso, O., Jané-Lara, A., López-Bueno, Y., & Hernández-Tapanes, S. (2004). Entrenamiento de los músculos respiratorios. Revista Cubana Medica Militar, 34(1), 1-7.
Burgomaster, H. H. (2005). Six sessions of sprint interval training increases muscle oxidative potential and cycle endurance capacity in humans. Journal of applied physiology. 99(6): 2473-7
Cader, S. A., Gomes de Souza Vale, R., Correa Castro, J., Correa Bacelar, S., Biehl, C., Vega Gomes, M. C., . . . Martin Dantas, E. H. (2010). Inspiratory muscle training improves maximal inspiratory pressure and may assiste weaning in older intubated patients: a randomised trial. Journal of Physiotherapy, 56(3): 171-177.
Caruso, P., Denari, S. D., Ruiz, S. A., Bernal, K. G., Manfrin, G. M., Friedrich, C., & Deheinzelin, D. (2005). Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients. Clinics, Sao Paulo, 60(6): 479-484.
Chang, A. T., Boots, R. J., Brown, M. G., Paratz, J., & Hodges , P. W. (2005). Reduced inspiratory muscle endurance following successful weaning from prolonged mechanical ventilation. Chest, 60(6): 553-559.
Charry-Segura, D., Lozano-Martínez, V., Rodríguez-Herrera, Y., Rodríguez-Medina, C. L. & Mogollón, P., (2013). Movilización Temprana, duración de la ventilación mecánica y la estancia en cuidados intensivos. Revista de la Facultad de Medicina, 61(4): 373-379.
Condessa. R, Brauner, J, Baptista. M, Silva. A, Vieira. S. (2013). Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. Journal of physiotherapy, 59, 101-107.
Coyle, E. F. (1999). Physiological determinants of endurance exercise performance. Journal od science and medicine in sport, 2(3): 181 - 189.
Crow, J., Reid, W. D., Geddes, E. L., O Brien, K., Brooks, D. (2005). Inspiratory muscle training compared with other rehabilitation interventions in adulst with chronic obstructive pumonary disease: a systematic literature review and meta-analysis. COPD, 319 -329.
Cubillos, V. Bohorquez, N., Martínez, S., Vargas, Z. (2008). Miopatía del paciente critico. Rev Mov Cient. 2(1): 21.
Durán, D., Aguiar, P., & Gómez, V. (2009). Efectos de un programa de rehabilitación pulmonar en un epoc severo. Ciencias de la Salud, Universidad del Rosario, 7(2), 30-35.
Elbouhy. M, AbdelHalim. H, Hashem. A. (2014). Effect of respiratory muscles training in weaning of mechanically ventilated COPD patients. Egyptian journal of chest diseases and tuberculosis, 63(3), 679-687.
Epstein, S. K. (2009). Weaning from Ventilatory Support. Current opinion in critical care, 15: 36-43.
Gastaldi, A., Magalhães, C., Baraúna, M., Silva, E., & Souza, H. (2008). Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy. Brazilian Journal of Physical Therapy, 12(2), 100-108.
Gili, T., Sanchez, S., & Pons, M. (2009). Principios de Ventilacion Mecanica. En J. P. Orive, Manual de Ventilacion Mecanica en Pediatria. Madrid - España: Publimed.
Hill, K., Jenkins, D., Philippe, N., Ceciins, K. L., Shepherd, D. J., Green, D. R., Hillman, P.R., Eastwood. (2006). High - intensity inspiratory muscle training in COPD. European respiratory Journal, 27(6): 1119 - 1128.
Ibrahiem. A A, Mohamed. AR, Saber. HM. (2014). Effect of respiratory muscles training in addition to standard chest physiotherapy on mechanically ventilated patients. Journal of medical reseach and practice, 3(3), 52-58.
Lizcano, D., Bermon, A. (2011). Factores asociados a la mortalidad y el tiempo de supervivencia en pacientes con ventilación mecánica espontánea con presión soporte en una unidad de cuidados intensivos de Antioquia. Tesis de Maestría. Unviersidad de Antioquia. Medellín-Colombia.
Lorenzo S, B. T. (2013). Ventilatory responses at peak exercise in endurance-trained obese adults. Chest Pulmonary physiology, 144(4), 1330-1339.
Manchado Garabito, R., Tamames Gómez, S., López González, M., Mohedano Macías, L., D´Agostino, M., & Veiga de Cabo, J. (2009). Revisiones Sistemáticas Exploratorias. En Medicina y seguridad del trabajo, 55: 12-19.
Martin D., Smith B, Gabrielli A. (2013). Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation perspective. Respir Physiol Neurobiol, 189(2): doi:10.1016/j.resp.2013.05.012.
Martin D., Smith B., Davenport P., Harman E., Gonzalez-Rothi R., Baz M., Layon J., Banner M., Caruso L., Deoqhare H., Huang T., Gabrielli, A. (2011). Inspiratory muscle strengh training improves weaning outcome in failure to wean patients: a randomized trial. Critical care, 15(2): R84.
Martin. D, Davenport. P, Franceschi. A, Harman.E. (2002). Use of inspiratory muscle strength training to facitilate ventilator weaning: a series of 10 consecutive patients. Chest Journal, 122(1), 192-196.
Mei. YC, L. Y. (2011). Chair-sitting exercise intervention does not improve respiratory muscle function in mechanically ventilated intensive care unit patients. Respiratory care, 56(10), 1533-1538.
Mondragón, A., Estrada, M., & Cadavid, D. (2014). Importancia de la recuperación nutricional para la realización de actividad física en pacientes. Revista movimiento y salud CES, 2(2): 101-113.
Moodie, L. H., Reeve, J. C., Vermeulen, N., & Elkins, M. R. (2011). Inspiratory muscle training to facilitate weaning from mechanical ventilation: protocol for a systematic review. BMC Research Notes, 4: 283.
Moodie, L., Reeve, J., & Elkins, M. (2011). Inspiratory muscle training increases inspiratory muscle strength in patients weaning from mechanical ventilation: a systematic review. Journal of Physioterapy, 4(57): 213-221.
Mora Bautista, G. (2008). El envejecimiento y la actividad física. Rev Mov Cient., 2(1).
Nava. S, F. L. (2011). Inspiratory muscle training in difficult to wean patients: work it harder, make it better, do it faster, makes us stronger. Critical care, 15(2): 153.
Needham, D. M. (2008). Mobilizing Patient in the Intensive Care Unit: Improving Neuromuscular Weakness and Physical Function. The Journal of the American Medical Association, 300: 1685-1690.
Orozco - Levy, Marco Navarro, Ramirez - Sarmiento. (2010). Entrenamiento de los músculos respiratorios: si o no? España: Elsevier doyma.
Patsaki, I. P. (2013). The effectiveness of inspiratory muscle training in weaning cricically ill patients from mechanical ventilation. Hospital chronicles, 8(2), 86-90.
Petrof, B. J., Jaber, S., & Matecki, S. (2010). Ventilator-induced diaphragmatic dysfunction. Current Opinion in Critical Care, 16(1): 19-25.
Pires, V.A., Jamami M., Oishi, J., Costa, D., Baldissera, V. (2000). Comparação de duas técnicas de treinamento muscular respiratório em pacientes sob ventilação mecânica com insucesso de desmame. Revista Brasileira de Fisioterapia, 4(2), 93-104.
Primo, J. (2003). Niveles de evidencia y grados de recomendación (I/II. Enfermedad Inflamatoria Intestinal al día, 2(2), 39-42.
Santos, A., Scarpelini, F., Soares, J., Gonçalves, M. (2001). Aplication of specific ventilatory muscular training during the extubation process of mechanical ventialtion - A case report. Disciplinarum Scientia. Série: Ciên. Biol. e da Saúde, Santa Maria, 2(1), 33-40.
Santos Pascotini F, , Denardi C., Oliveira Nunes G., Elaine Trevisan M., da Pieve Antunes V. (2014). Treinamento muscular respiratório em pacientes em desmame da ventilação mecânica. ABCS health sciences, 39(1): 12-16.
Shimizu. J, Manzano. R, Quitério. R, Costa V da, Junqueira. T., El-Fakhouri. S, Ambrozin. A. (2014). Determinant factors for mortality of patients receiving mechanical ventilation and effects of a protocol muscle training in weaning. Manual therapy, posturology & rehabilitation journal, 12, 136-142.
Smith. B, G. A. (2015). Effect of training on inspiratory load compensation in weaned and unweaned mechanically ventilated ICU patients. Respir Care, 59(1), 22-31.
Sprague, S. S., & Hopkins, P. D. (2003). Use of Inspiratory Strength Training to Wean Six Patients Who Were Ventilator-Dependent. Journal of the American Physical Therapy Association, 2(83): 171-181.
Truong, A. D., Fan, E., Brower, R. G., & Needham, D. M. (2009). Bench-to-bedside review: Mobilizing patients in the intensive care unit- from pathophysiology to clinical trials. Crit Care, 13(4): 216-228.
Yen. HC, Hui. LL, Hsiu. FH, Lan. TC, Kuo. CH, Ying HT. (2012). Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation. respiratoy care, 57(5): 727-734.
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spelling Hernández Santacruz, Helen Katherineb32ddf3b238b0e6e49b598bce47558dd500Laverde Moreno, Camila052ed4d2f5605bf27018d41a56f5feee500Soler Torres, Alfredoc3709edd2bfce58fb47d718a677b4324500Alejo de Paula, Luz Angelaebf57fcfba7960730e0e85496d1a1a222016-06-13 00:00:002022-06-14T21:52:07Z2016-06-13 00:00:002022-06-14T21:52:07Z2016-06-13application/pdf10.33881/2011-7191.%x2463-22362011-7191https://repositorio.ibero.edu.co/handle/001/4448https://doi.org/10.33881/2011-7191.%xspaCorporación Universitaria Iberoamericanahttps://revmovimientocientifico.ibero.edu.co/article/download/994/790Núm. 2 , Año 2015 : Revista Movimiento Científico602479Movimiento CientíficoAcosta, T. B., Díaz, P. A., Alonso, O. V., Lara, A. J., Bueno, Y. L., & Hernández, S. (2005). Entrenamiento de los músculos respiratorios. (Spanish). Revista Cubana De Medicina Militar, 34(1), 1-5.Aldrich, T. K., Karpel, J. P., Uhrlass, R. M., Sparapani, M. A., Eramo, D., & Ferranti, R. (1989). Weaning from mechanical ventilation: adjunctive use of inspiratory muscle resistive training. Critical care medicine, 17: 143-147.Belman, M. J. (1981). Respiratory failure treated by ventilatory muscle training (VMT). A report of two cases. European Journal of respiratory diseases, 62(6): 391-395.Bisset, B., Leditschke, I. A., Paratz, J. D., & Boots, R. J (2012). Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial. BMJ Open, 2(2). Disponible en: http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3293141/pdf/bmjopen-2012-000813.pdfBissett, B., Leditschke, I. A., Paratz, J. D., & Boots, R. J. (2012). Respiratory dysfunction in ventilated patients: Can inspiratory muscle training help? Anaesth Intensive Care, 40: 236-246.Boles, J. M., Bion, J., Connors, A., Herridge , M., Marsh, B., Melot, C., . . . Welte, T. (2007). Weaning from Mechanical Ventilation. The european Respiratory Journal, 29(5): 1033-1056.Bonnevie, T., Villiot- Danger, J. C., Gravier, F. E., Dupuis, J., Prieur, G., & Médrinal, C. (2015). Inspiratory muscle training is used in some intensive care units, but many training methods have uncertain efficacy: a survey of French physiotherapists. Journal of Physiotherapy, 61(4): 180-186.Bourdin , G., Barbier, J., Burle, J. F., Durante, G., Passant, S., Vincent, B., . . . Guérin, C. (2010). The feasibility of early physical activity in intensive care unit patient: a prospective observational one-center study. Respiratory Care, 55(4):400-407.Bravo-Acosta, T., Alonso-Díaz, P. L., del Valle-Alonso, O., Jané-Lara, A., López-Bueno, Y., & Hernández-Tapanes, S. (2004). Entrenamiento de los músculos respiratorios. Revista Cubana Medica Militar, 34(1), 1-7.Burgomaster, H. H. (2005). Six sessions of sprint interval training increases muscle oxidative potential and cycle endurance capacity in humans. Journal of applied physiology. 99(6): 2473-7Cader, S. A., Gomes de Souza Vale, R., Correa Castro, J., Correa Bacelar, S., Biehl, C., Vega Gomes, M. C., . . . Martin Dantas, E. H. (2010). Inspiratory muscle training improves maximal inspiratory pressure and may assiste weaning in older intubated patients: a randomised trial. Journal of Physiotherapy, 56(3): 171-177.Caruso, P., Denari, S. D., Ruiz, S. A., Bernal, K. G., Manfrin, G. M., Friedrich, C., & Deheinzelin, D. (2005). Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients. Clinics, Sao Paulo, 60(6): 479-484.Chang, A. T., Boots, R. J., Brown, M. G., Paratz, J., & Hodges , P. W. (2005). Reduced inspiratory muscle endurance following successful weaning from prolonged mechanical ventilation. Chest, 60(6): 553-559.Charry-Segura, D., Lozano-Martínez, V., Rodríguez-Herrera, Y., Rodríguez-Medina, C. L. & Mogollón, P., (2013). Movilización Temprana, duración de la ventilación mecánica y la estancia en cuidados intensivos. Revista de la Facultad de Medicina, 61(4): 373-379.Condessa. R, Brauner, J, Baptista. M, Silva. A, Vieira. S. (2013). Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. Journal of physiotherapy, 59, 101-107.Coyle, E. F. (1999). Physiological determinants of endurance exercise performance. Journal od science and medicine in sport, 2(3): 181 - 189.Crow, J., Reid, W. D., Geddes, E. L., O Brien, K., Brooks, D. (2005). Inspiratory muscle training compared with other rehabilitation interventions in adulst with chronic obstructive pumonary disease: a systematic literature review and meta-analysis. COPD, 319 -329.Cubillos, V. Bohorquez, N., Martínez, S., Vargas, Z. (2008). Miopatía del paciente critico. Rev Mov Cient. 2(1): 21.Durán, D., Aguiar, P., & Gómez, V. (2009). Efectos de un programa de rehabilitación pulmonar en un epoc severo. Ciencias de la Salud, Universidad del Rosario, 7(2), 30-35.Elbouhy. M, AbdelHalim. H, Hashem. A. (2014). Effect of respiratory muscles training in weaning of mechanically ventilated COPD patients. Egyptian journal of chest diseases and tuberculosis, 63(3), 679-687.Epstein, S. K. (2009). Weaning from Ventilatory Support. Current opinion in critical care, 15: 36-43.Gastaldi, A., Magalhães, C., Baraúna, M., Silva, E., & Souza, H. (2008). Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy. Brazilian Journal of Physical Therapy, 12(2), 100-108.Gili, T., Sanchez, S., & Pons, M. (2009). Principios de Ventilacion Mecanica. En J. P. Orive, Manual de Ventilacion Mecanica en Pediatria. Madrid - España: Publimed.Hill, K., Jenkins, D., Philippe, N., Ceciins, K. L., Shepherd, D. J., Green, D. R., Hillman, P.R., Eastwood. (2006). High - intensity inspiratory muscle training in COPD. European respiratory Journal, 27(6): 1119 - 1128.Ibrahiem. A A, Mohamed. AR, Saber. HM. (2014). Effect of respiratory muscles training in addition to standard chest physiotherapy on mechanically ventilated patients. Journal of medical reseach and practice, 3(3), 52-58.Lizcano, D., Bermon, A. (2011). Factores asociados a la mortalidad y el tiempo de supervivencia en pacientes con ventilación mecánica espontánea con presión soporte en una unidad de cuidados intensivos de Antioquia. Tesis de Maestría. Unviersidad de Antioquia. Medellín-Colombia.Lorenzo S, B. T. (2013). Ventilatory responses at peak exercise in endurance-trained obese adults. Chest Pulmonary physiology, 144(4), 1330-1339.Manchado Garabito, R., Tamames Gómez, S., López González, M., Mohedano Macías, L., D´Agostino, M., & Veiga de Cabo, J. (2009). Revisiones Sistemáticas Exploratorias. En Medicina y seguridad del trabajo, 55: 12-19.Martin D., Smith B, Gabrielli A. (2013). Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation perspective. Respir Physiol Neurobiol, 189(2): doi:10.1016/j.resp.2013.05.012.Martin D., Smith B., Davenport P., Harman E., Gonzalez-Rothi R., Baz M., Layon J., Banner M., Caruso L., Deoqhare H., Huang T., Gabrielli, A. (2011). Inspiratory muscle strengh training improves weaning outcome in failure to wean patients: a randomized trial. Critical care, 15(2): R84.Martin. D, Davenport. P, Franceschi. A, Harman.E. (2002). Use of inspiratory muscle strength training to facitilate ventilator weaning: a series of 10 consecutive patients. Chest Journal, 122(1), 192-196.Mei. YC, L. Y. (2011). Chair-sitting exercise intervention does not improve respiratory muscle function in mechanically ventilated intensive care unit patients. Respiratory care, 56(10), 1533-1538.Mondragón, A., Estrada, M., & Cadavid, D. (2014). Importancia de la recuperación nutricional para la realización de actividad física en pacientes. 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Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation. respiratoy care, 57(5): 727-734.info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2https://creativecommons.org/licenses/by-nc-sa/4.0/https://revmovimientocientifico.ibero.edu.co/article/view/994Entrenamiento de músculos respiratoriosUnidad de cuidado intensivoFuerza de resistenciaVentilación mecánicaIntervención en la fuerza de resistencia de los músculos respiratorios en pacientes adultos en la unidad de cuidado intensivoArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/version/c_970fb48d4fbd8a85Textinfo:eu-repo/semantics/articleArtículosArticleshttp://purl.org/redcol/resource_type/ARTREFinfo:eu-repo/semantics/publishedVersionPublicationOREORE.xmltext/xml2785https://repositorio.ibero.edu.co/bitstreams/4810eb0a-9293-4c18-a0b2-22a71365de48/download3600e509af6975e0f746289cdf1acdccMD51001/4448oai:repositorio.ibero.edu.co:001/44482023-04-08 13:43:14.19https://creativecommons.org/licenses/by-nc-sa/4.0/https://repositorio.ibero.edu.coRepositorio Institucional - IBERO.bdigital@metabiblioteca.com