10 research outputs found
FACTORES PREDICTIVOS DEL FRACASO DE LA OXIGENOTERAPIA ALTO FLUJO EN LA INFECCIĂN POR SARS-COV-2
Objetivo: Explorar los factores clĂnicos que predicen el fracaso terapĂ©utico de la oxigenoterapia alto flujo (OAF) con cĂĄnulas nasales en pacientes con diagnĂłstico de insuficiencia respiratoria hipoxĂ©mica aguda por SARS-CoV-2 ingresados en un entorno de cuidados no intensivos.Material y mĂ©todos: Estudio observacional, analĂtico, retrospectivo, de cohortes, en el que se han recogido datos de pacientes adultos ingresados en el servicio de NeumologĂa del Hospital ClĂnico Universitario Lozano Blesa entre julio de 2020 y febrero de 2021. Los criterios de inclusiĂłn fueron infecciĂłn confirmada de SARS-CoV-2, sĂntomas, signos y gasometrĂa compatibles con SĂndrome de DistrĂ©s Respiratorio Agudo (SDRA) definido por PaO2/FiO2 ratio †300, fallo de la oxigenoterapia convencional e inicio de la OAF en la unidad de cuidados intermedios respiratorios. Los parĂĄmetros de la OAF se configuraron para intentar conseguir una SpO2 >94%. Se definiĂł como criterio de fracaso de la OAF la necesidad de intubaciĂłn orotraqueal o el Ă©xitus del paciente. Para analizar los posibles factores clĂnicos que se asociaron al fracaso de la OAF se aplicĂł un modelo de regresiĂłn logĂstica mĂșltiple y se considerĂł un valor de pResultados: Un total de 168 pacientes han sido incluidos en el estudio (edad media: 68; varones: 61%; entre las comorbilidades mĂĄs frecuentes, 55% tenĂan hipertensiĂłn arterial, 46% obesidad, 32% eran diabĂ©ticos y 29% tenĂan diagnĂłstico previo de patologĂa neumolĂłgica). Del total de la muestra, un 67% cumplieron criterios de fracaso para la OAF. La probabilidad de fallo de la OAF fue mayor en personas con mayor edad (OR=1.08; [1.04-1.12]), obesas (OR= 2.18; [1.01-4.68]) y en aquellas con requerimiento precoz de OAF tras el inicio de los sĂntomas (OR= 0.88; [0.81-0.97]). Ni la hipertensiĂłn arterial, ni la diabetes, ni la presencia de patologĂa neumolĂłgica ni el nĂșmero de sĂntomas al ingreso se relacionaron con el fracaso de la OAF.Conclusiones: En pacientes con infecciĂłn por SARS-CoV-2, la edad, la obesidad y el requerimiento precoz de OAF tras el inicio de los sĂntomas, parecen ser factores predictivos del fracaso de la OAF en una unidad de cuidados intermedios respiratorios.Palabras clave: SARS-CoV-2, SĂndrome de DistrĂ©s Respiratorio Agudo (SDRA), Oxigenoterapia alto flujo (OAF), Fracaso<br /
ADHERENCIA TERAPĂUTICA Y ABUSO DE TRATAMIENTO DE ALIVIO SINTOMĂTICO EN PACIENTES CON AGUDIZACIĂN DE ASMA BRONQUIAL
INTRODUCCIĂNClĂĄsicamente el tratamiento del asma se basa en distintos fĂĄrmacos utilizados como tratamiento de mantenimiento y a demanda. En los Ășltimos años sigue en debate la opciĂłn de utilizar un solo dispositivo de inhalaciĂłn con formoterol/GCI para ambas modalidades ya que se ha comprobado que disminuye las consecuencias de la baja adherencia terapĂ©utica y del abuso del tratamiento de rescate, que se han relacionado en mĂșltiples ocasiones con un mayor riesgo de sufrir exacerbaciones. MATERIAL Y MĂTODOSSe trata de un estudio descriptivo transversal en el que se ha incluido a todo paciente acudido al Servicio de Urgencias del HCU Lozano Blesa por una exacerbaciĂłn asmĂĄtica durante el periodo del 1/12/2021 al 31/1/2022 obteniendo un tamaño muestral final de 40 pacientes. Se han recogido las siguientes variables: edad, sexo, nĂșmero de exacerbaciones asmĂĄticas en el Ășltimo año divididas en leves y graves, tratamiento de rescate utilizado (SABA vs Formoterol/GCI), nĂșmero de dispensaciones farmacĂ©uticas de Ă©ste, abuso del tratamiento de rescate y adherencia terapĂ©uticaRESULTADOSUn 55% de los pacientes estudiados utilizaban SABA como tratamiento de rescate, mientras que un 45% utilizaban formoterol/GCI. Un 72,5% eran mujeres y la edad media era de 47,42 años. Se registraron 60 exacerbaciones en total, un 65% de ellas graves con una media de 1,5 exacerbaciones por paciente. Un 35% no presentĂł ninguna exacerbaciĂłn. De los pacientes con SABA, un 36,4% cumplĂan criterios de abuso. De aquellos con formoterol/GCI un 83,3% lo hacĂa de mala adherencia terapĂ©utica. No se encontraron diferencias en el nĂșmero de exacerbaciones entre los pacientes con SABA y aquellos con formoterol/GCI. SĂłlo se ha encontrado una relaciĂłn levemente significativa (p=0,046) entre el abuso de SABA y el nĂșmero de exacerbaciones. CONCLUSIĂNEl abuso de SABA se ha relacionado con un incremento de las exacerbaciones por mal control de la enfermedad. Son necesarios mĂĄs estudios que corroboren el papel de las combinaciones de LABA/GCI como tratamiento de rescate en los primeros escalones terapĂ©uticos del asma bronquial<br /
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Proceedings of the 13th annual conference of INEBRIA
CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.The original publication is available at https://ascpjournal.biomedcentral.comENGLISH SUMMARY : Meeting abstracts.https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0062-9Publisher's versio
Perfil de eficiencia de respiradores domiciliarios bajo distintas condiciones de obstruccion de vias aereas
IntroducÆ on: Noninvasive mechanical venÆ laÆ on (NIV) adaptaÆ on should be performed in hospi-talizaÆ on. When there is an indicaÆ on to conÆ nue this treatment at home, someÆ mes the model of the device that has served for adaptaÆ on is replaced, because only some venÆ latory parameters are required for the installaÆ on. The variaÆ ons between diff erent models and their impact on paÆ ents venÆ latory me-chanics in home venÆ laÆ on are unknown. The aim was to demonstrate whether there are disÆ ncÆ ons in volumes and FiO2 between diff erent NIV devices under diff erent condiÆ ons of airway obstrucÆ on.
Methods: A quasi-experimental study was performed, in which 6 models of venÆ lators were as-sessed and connected to an arÆfi cial lung with two degrees of resistance (20 and 50 cmH2O/L/s) under a fi xed compliance (50 ml/cmH2O). All respirators were similarly confi gured. A single circuit and a contro-lled leak was used. The parameters evaluated and tested were: IPAP, EPAP, Rr, Tv and Mv. The FiO2 was measured in two points of the circuit. Results: When the level of obstrucÆ on increased, the volumes tended to decrease in all venÆ lators. The volumes shown in the screen of all respirators were lower than the tested in almost all the devices. By increasing the obstrucÆ on, signifi cant changes in FiO2 were observed.Conclusions: The overall percepÆ on of the relaÆ ves of deceased paÆ ents about the quality of health-care during the last days of life was good. We detected the following areas of improvement: 1) AÆ© enÆ on to emoÆ onal, psychological and spiritual needs of the family; 2) InformaÆ on about the prognosis of the disease and about the process; 3) CommunicaÆ on skills of sanitary professionals.IntroducciĂłn: La adaptaciĂłn a la venÆ laciĂłn mecĂĄnica no invasiva (VMNI) debe realizarse en el medio hospitalario. Cuando existe indicaciĂłn de conÆ nuar este tratamiento en el domicilio, en ocasiones se susÆ tuye el modelo del disposiÆ vo que ha servido para la adaptaciĂłn, ya que sĂłlo se exigen una serie de parĂĄmetros en su instalaciĂłn. Se desconocen las variaciones entre las disÆ ntas marcas comerciales y su repercusiĂłn sobre la mecĂĄnica venÆ latoria del paciente en el domicilio. El objeÆ vo fue demostrar si existen diferencias en los volĂșmenes aportados y en la FiO2 entre los disÆ ntos modelos de equipos domiciliarios de VMNI bajo diferentes condiciones de obstrucciĂłn de la vĂa aĂ©rea.MĂ©todo: Se realizĂł un estudio cuasi-experimental, en el que se valoraron 6 diferentes equipos. Cada uno fue evaluado y conectado a un pulmĂłn arÆfi cial con ajuste a dos grados de resistencia (20 y 50 cmH2O/L/s), bajo una compliance fi ja (50 ml/cmH2O). Todos los respiradores se confi guraron igual, se empleĂł un circuito Ășnico y una fuga fi ja. Los valores evaluados y testados fueron: IPAP, EPAP, Fr, Vt y Vm. La FiO2 se cualifi cĂł en dos puntos del circuito. Resultados: Cuando se incrementĂł el nivel de obstrucciĂłn, los volĂșmenes de venÆ laciĂłn disminu-yeron. Los volĂșmenes obtenidos en pantalla de los respiradores estaban por debajo de los testados en la mayorĂa de los equipos. Al incrementar la obstrucciĂłn, se observaron cambios signifi caÆ vos entre las FiO2. Conclusiones: Tras la adaptaciĂłn a la VMNI hospitalaria, se recomienda mantener el mismo equi-po en el domicilio para garanÆ zar un adecuado soporte venÆ latori
Tumor del sulcus pulmonar superior y hombro doloroso. Reflexiones de un caso
El tumor de Pancoast o tumor del sulcus pulmonar superior representa sĂłlo el 5% de casos de carcinoma pulmonar, siendo una forma peculiar de presentaciĂłn clĂnica y topogrĂĄfica, con invasiĂłn predominantemente parietal. Se describe el caso de paciente con hombro doloroso y sĂndrome constitucional en contexto de hallazgo radiolĂłgico de masa pulmonar apical derecha con invasiĂłn costal local correspondiente a tumor de pancoast
Reliability and Validity of Computerized Adventitious Respiratory Sounds in People with Bronchiectasis
Background: Computerized adventitious respiratory sounds (ARS), such as crackles and wheezes, have been poorly explored in bronchiectasis, especially their measurement properties. This study aimed to test the reliability and validity of ARS in bronchiectasis. Methods: Respiratory sounds were recorded twice at 4 chest locations on 2 assessment sessions (7 days apart) in people with bronchiectasis and daily sputum expectoration. The total number of crackles, number of wheezes and wheeze occupation rate (%) were the parameters extracted. Results: 28 participants (9 men; 62 ± 12 y) were included. Total number of crackles and wheezes showed moderate within-day (ICC 0.87, 95% CI 0.74â0.94; ICC 0.86, 95% CI 0.71â0.93) and between-day reliability (ICC 0.70, 95% CI 0.43â0.86; ICC 0.78, 95% CI 0.56â0.90) considering all chest locations and both respiratory phases; wheeze occupation rate showed moderate within-day reliability (ICC 0.86, 95% CI 0.71â0.93), but poor between-day reliability (ICC 0.71, 95% CI 0.33â0.87). BlandâAltman plots revealed no systematic bias, but wide limits of agreement, particularly in the between-days analysis. All ARS parameters correlated moderately with the amount of daily sputum expectoration (r > 0.4; p < 0.05). No other significant correlations were observed. Conclusion: ARS presented moderate reliability and were correlated with the daily sputum expectoration in bronchiectasis. The use of sequential measurements may be an option to achieve greater accuracy when ARS are used to monitor or assess the effects of physiotherapy interventions in this population
A systematic review of alcohol screening and assessment measures for young people
CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.The original publication is available at https://ascpjournal.biomedcentral.comENGLISH SUMMARY : Meeting abstracts.https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0062-9Publisher's versio
The burden of mild asthma: Clinical burden and healthcare resource utilisation in the NOVELTY study
Background: Patients with mild asthma represent a substantial proportion of the population with asthma, yet there are limited data on their true burden of disease. We aimed to describe the clinical and healthcare resource utilisation (HCRU) burden of physician-assessed mild asthma.Methods: Patients with mild asthma were included from the NOVEL observational longiTudinal studY (NOVELTY; NCT02760329), a global, 3-year, real-world prospective study of patients with asthma and/or chronic obstructive pulmonary disease from community practice (specialised and primary care). Diagnosis and severity were based on physician discretion. Clinical burden included physician-reported exacerbations and patient-reported measures. HCRU included inpatient and outpatient visits.Results: Overall, 2004 patients with mild asthma were included; 22.8% experienced â„1 exacerbation in the previous 12 months, of whom 72.3% experienced â„1 severe exacerbation. Of 625 exacerbations reported, 48.0% lasted >1 week, 27.7% were preceded by symptomatic worsening lasting >3 days, and 50.1% required oral corticosteroid treatment. Health status was moderately impacted (St George's Respiratory Questionnaire score: 23.5 [standard deviation ± 17.9]). At baseline, 29.7% of patients had asthma symptoms that were not well controlled or very poorly controlled (Asthma Control Test score <20), increasing to 55.6% for those with â„2 exacerbations in the previous year. In terms of HCRU, at least one unscheduled ambulatory visit for exacerbations was required by 9.5% of patients, including 9.2% requiring â„1 emergency department visit and 1.1% requiring â„1 hospital admission.Conclusions: In this global sample representing community practice, a significant proportion of patients with physician-assessed mild asthma had considerable clinical burden and HCRU
Treatable traits in the NOVELTY study
CorrigendumVolume 27, Issue 12, Respirology, pages: 1095-1095. First Published online: November 6, 2022 10.1111/resp.14406International audienceAsthma and chronic obstructive pulmonary disease (COPD) are two prevalent and complex diseases that require personalized management. Although a strategy based on treatable traits (TTs) has been proposed, the prevalence and relationship of TTs to the diagnostic label and disease severity established by the attending physician in a real-world setting are unknown. We assessed how the presence/absence of specific TTs relate to the diagnosis and severity of 'asthma', 'COPD' or 'asthmaâ+âCOPD'
The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study
AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4âweeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4âweeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, PÂ =Â 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, PâConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease