FACTORES PREDICTIVOS DEL FRACASO DE LA OXIGENOTERAPIA ALTO FLUJO EN LA INFECCIÓN POR SARS-COV-2

Objetivo: Explorar los factores clínicos que predicen el fracaso terapéutico de la oxigenoterapia alto flujo (OAF) con cánulas nasales en pacientes con diagnóstico de insuficiencia respiratoria hipoxémica aguda por SARS-CoV-2 ingresados en un entorno de cuidados no intensivos.Material y métodos: Estudio observacional, analítico, retrospectivo, de cohortes, en el que se han recogido datos de pacientes adultos ingresados en el servicio de Neumología del Hospital Clínico Universitario Lozano Blesa entre julio de 2020 y febrero de 2021. Los criterios de inclusión fueron infección confirmada de SARS-CoV-2, síntomas, signos y gasometría compatibles con Síndrome de Distrés 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 parámetros de la OAF se configuraron para intentar conseguir una SpO2 >94%. Se definió como criterio de fracaso de la OAF la necesidad de intubación orotraqueal o el éxitus del paciente. Para analizar los posibles factores clínicos que se asociaron al fracaso de la OAF se aplicó un modelo de regresión logística múltiple y se consideró un valor de pResultados: Un total de 168 pacientes han sido incluidos en el estudio (edad media: 68; varones: 61%; entre las comorbilidades más frecuentes, 55% tenían hipertensión arterial, 46% obesidad, 32% eran diabéticos y 29% tenían diagnóstico previo de patología neumológica). 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 síntomas (OR= 0.88; [0.81-0.97]). Ni la hipertensión arterial, ni la diabetes, ni la presencia de patología neumológica ni el número de síntomas al ingreso se relacionaron con el fracaso de la OAF.Conclusiones: En pacientes con infección por SARS-CoV-2, la edad, la obesidad y el requerimiento precoz de OAF tras el inicio de los síntomas, parecen ser factores predictivos del fracaso de la OAF en una unidad de cuidados intermedios respiratorios.Palabras clave: SARS-CoV-2, Síndrome de Distrés Respiratorio Agudo (SDRA), Oxigenoterapia alto flujo (OAF), Fracaso<br /

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

IntroducƟ on: Noninvasive mechanical venƟ laƟ on (NIV) adaptaƟ on should be performed in hospi-talizaƟ on. When there is an indicaƟ on to conƟ nue this treatment at home, someƟ mes the model of the device that has served for adaptaƟ on is replaced, because only some venƟ latory parameters are required for the installaƟ on. The variaƟ ons between diff erent models and their impact on paƟ ents venƟ latory me-chanics in home venƟ laƟ on are unknown. The aim was to demonstrate whether there are disƟ ncƟ ons in volumes and FiO2 between diff erent NIV devices under diff erent condiƟ ons of airway obstrucƟ on. Methods: A quasi-experimental study was performed, in which 6 models of venƟ lators were as-sessed and connected to an arƟfi 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 obstrucƟ on increased, the volumes tended to decrease in all venƟ lators. The volumes shown in the screen of all respirators were lower than the tested in almost all the devices. By increasing the obstrucƟ on, signifi cant changes in FiO2 were observed.Conclusions: The overall percepƟ on of the relaƟ ves of deceased paƟ ents about the quality of health-care during the last days of life was good. We detected the following areas of improvement: 1) AƩ enƟ on to emoƟ onal, psychological and spiritual needs of the family; 2) InformaƟ on about the prognosis of the disease and about the process; 3) CommunicaƟ on skills of sanitary professionals.Introducción: La adaptación a la venƟ lación mecánica no invasiva (VMNI) debe realizarse en el medio hospitalario. Cuando existe indicación de conƟ nuar este tratamiento en el domicilio, en ocasiones se susƟ tuye el modelo del disposiƟ vo que ha servido para la adaptación, ya que sólo se exigen una serie de parámetros en su instalación. Se desconocen las variaciones entre las disƟ ntas marcas comerciales y su repercusión sobre la mecánica venƟ latoria del paciente en el domicilio. El objeƟ vo fue demostrar si existen diferencias en los volúmenes aportados y en la FiO2 entre los disƟ ntos modelos de equipos domiciliarios de VMNI bajo diferentes condiciones de obstrucción de la vía aérea.Método: Se realizó un estudio cuasi-experimental, en el que se valoraron 6 diferentes equipos. Cada uno fue evaluado y conectado a un pulmón arƟfi 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 empleó un circuito único y una fuga fi ja. Los valores evaluados y testados fueron: IPAP, EPAP, Fr, Vt y Vm. La FiO2 se cualifi có en dos puntos del circuito. Resultados: Cuando se incrementó el nivel de obstrucción, los volúmenes de venƟ lación disminu-yeron. Los volúmenes obtenidos en pantalla de los respiradores estaban por debajo de los testados en la mayoría de los equipos. Al incrementar la obstrucción, se observaron cambios signifi caƟ vos entre las FiO2. Conclusiones: Tras la adaptación a la VMNI hospitalaria, se recomienda mantener el mismo equi-po en el domicilio para garanƟ zar un adecuado soporte venƟ latori

Tumor del sulcus pulmonar superior y hombro doloroso. Reflexiones de un caso

El tumor de Pancoast o tumor del sulcus pulmonar superior representa sólo el 5% de casos de carcinoma pulmonar, siendo una forma peculiar de presentación clínica y topográfica, con invasión predominantemente parietal. Se describe el caso de paciente con hombro doloroso y síndrome constitucional en contexto de hallazgo radiológico de masa pulmonar apical derecha con invasión 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 0.74–0.94; ICC 0.86, 95% CI 0.71–0.93) and between-day reliability (ICC 0.70, 95% CI 0.43–0.86; ICC 0.78, 95% CI 0.56–0.90) considering all chest locations and both respiratory phases; wheeze occupation rate showed moderate within-day reliability (ICC 0.86, 95% CI 0.71–0.93), but poor between-day reliability (ICC 0.71, 95% CI 0.33–0.87). Bland–Altman 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 &gt; 0.4; p &lt; 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

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 ≥1 exacerbation in the previous 12 months, of whom 72.3% experienced ≥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 ≥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 ≥1 emergency department visit and 1.1% requiring ≥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 'asthma + COPD'

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 4 weeks 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 4 weeks. 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%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne 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