Implicaciones de la calidad de vida en las decisiones quirúrgicas del cáncer de pulmón

Available evidence suggests that the patients with a forced expiratory volume in 1 second [FEV1] over 60% or in which a postoperative FEV1 is predicted over 45%, they do not develop severe disability after lung resection surgery; nevertheless, currently some groups are operating patients with EPOC and FEV1 less than 35%. In emphysema patients can occur that the function improve, as in the volume reduction lung surgery, but in the cases that it does not occur, they can remain with chronic shortness of breath until a 10%. At present, there are not any functional or effort test that be able to predict what patients will present satisfactory residual pulmonary function or chronic shortness of breath or important exercise limitations. It has been noticed that medical team opinion is not satisfactory to predict defi cit in postoperative quality of life. Nevertheless, long-term survivors (more than one year) inform relatively good quality of life, even in which they have pulmonary function reduced. In comparison with other chronic respiratory diseases, the survivors of lung cancer seem to be in better psychological state, the defi cit in quality of life is caused mainly by depression, and not for physical limitation. Therefore, empirical evidence does not justify excluding undergoing surgery on basis of medical team suppositions about a postoperative poor Quality of life. In addition, studies about Quality of Life suggests patients who is undergo lung cancer surgery are willing to assume risks for their survival, although, they want to receive information about how surgery may affect them

Implicaciones de la calidad de vida en las decisiones quirúrgicas del cáncer de pulmón

Available evidence suggests that the patients with a forced expiratory volume in 1 second [FEV1] over 60% or in which a postoperative FEV1 is predicted over 45%, they do not develop severe disability after lung resection surgery; nevertheless, currently some groups are operating patients with EPOC and FEV1 less than 35%. In emphysema patients can occur that the function improve, as in the volume reduction lung surgery, but in the cases that it does not occur, they can remain with chronic shortness of breath until a 10%. At present, there are not any functional or effort test that be able to predict what patients will present satisfactory residual pulmonary function or chronic shortness of breath or important exercise limitations. It has been noticed that medical team opinion is not satisfactory to predict defi cit in postoperative quality of life. Nevertheless, long-term survivors (more than one year) inform relatively good quality of life, even in which they have pulmonary function reduced. In comparison with other chronic respiratory diseases, the survivors of lung cancer seem to be in better psychological state, the defi cit in quality of life is caused mainly by depression, and not for physical limitation. Therefore, empirical evidence does not justify excluding undergoing surgery on basis of medical team suppositions about a postoperative poor Quality of life. In addition, studies about Quality of Life suggests patients who is undergo lung cancer surgery are willing to assume risks for their survival, although, they want to receive information about how surgery may affect them

WITHDRAWN: La enfermedad pulmonar obstructiva crónica como factor de riesgo cardiovascular

This article has been withdrawn at the request of the author(s) and editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy

Ecuaciones de referencia de la capacidad aeróbica máxima ciclo-ergoespirometría para la población española adulta

[EN] Background: Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake ( ̇VO2 ) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. Methods: 182 men and women, 20–85 years old, were included and exercised on cycle-ergometer to exhaustion. ( ̇VO2 ) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. Results: Height, sex and age resulted predictive of both ̇VO2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas ̇VO2 peak = 0.017 · height (cm) − 0.023 · age (years) + 0.864 · sex (female = 0/male = 1) ± 179 l min−1 , and peak WR = 1.345 · height (cm) − 2.074 · age (years) + 76.54 · sex (female = 0/male = 1) ± 21.2 W were the best compromise between accuracy and parsimony. Conclusions: This study provides new and accurate ̇VO2 peak and WR rate reference values for individuals of European Spanish descent[ES] Antecedentes: Los valores de referencia utilizados con frecuencia para las pruebas de esfuerzo clínicas derivan de muestras no aleatorias y los criterios máximos para algunos de ellos están mal definidos. Nuestro objetivo fue obtener valores de referencia basados en la población general para el consumo máximo de oxígeno (VO 2 ) y la carga de trabajo (CT) para las pruebas de ejercicio cardiopulmonar a partir de una muestra representativa de varones y mujeres caucásicos españoles. Métodos: Se incluyeron 182 varones y mujeres, de entre 20 y 85 a ̃nos, que realizaron ejercicio en el cicloergómetro hasta el agotamiento. Se midieron el VO 2 y la CT. Las ecuaciones obtenidas de esta muestra se validaron en una cohorte independiente de 69 individuos, seleccionados aleatoriamente de la misma población. A continuación, se creó una ecuación final que fusionó las dos cohortes (n = 251). Resultados: La altura, el sexo y la edad resultaron predictivos tanto del ̇VO2 máximo como de la CT. El peso y la actividad física contribuyeron muy poco a la precisión de las ecuaciones. Las fórmulas ̇VO2 máximo = 0,017 × altura (cm) − 0,023 × edad (a ̃nos) + 0,864 × sexo (mujer = 0/varón = 1) ± 179 L × min−1 ; y CT máxima = 1,345 × altura (cm) − 2,074 × edad (a ̃nos) + 76,54 × sexo (mujer = 0/varón = 1) ± 21,2 W fueron el mejor equilibrio entre precisión y parsimonia. Conclusiones: Este estudio proporciona valores de referencia del ̇VO 2 máximo y la CT nuevos y precisos para personas de ascendencia espa ̃nola europea.This study was supported by a SEPAR (Sociedad Española de Neumología y Cirugía Torácica/Spanish society of Pulmonology and Thoracic Surgery) grant and NEUMOMADRD (Sociedad Madrileña de Neumología y Cirugía Torácica/Madrilenian Society of Pulmonology and Thoracic Surgery) research award

All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic

Introducción. Las terapias respiratorias no invasivas (TRNI) fueron ampliamente utilizadas en la primera ola de la pandemia de COVID-19, en escenarios distintos según los medios disponibles. El objetivo fue presentar la supervivencia a 90 días y los factores asociados a esta de los pacientes tratados con TRNI en un centro de tercer nivel sin Unidad de Cuidados Respiratorios Intermedios. Como objetivo secundario comparar los resultados obtenidos de las distintas terapias. Métodos. Estudio observacional de pacientes tratados con TRNI fuera de un ambiente de Cuidados Intensivos o Unidad de Cuidados Respiratorios Intermedios, diagnosticados de COVID-19 y con síndrome de distrés respiratorio agudo por criterios radiológicos y de ratio SpO2/FiO2. Se desarrolló un modelo multivariante de regresión logística para determinar las variables independientemente asociadas, y se compararon los resultados de la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea. Resultados. Se trataron 107 pacientes y sobrevivieron 85 (79,4%) a los 90 días. Antes de iniciar la TRNI el ratio medio de SpO2/FiO2 fue de 119,8±59,4. Un mayor score de SOFA se asoció significativamente a la mortalidad (OR 2,09; IC95% 1,34 – 3,27), mientras que la autopronación fue un factor protector (OR 0,23; IC95% 0,06 – 0,91). La terapia de alto flujo con cánula nasal fue utilizada en 63 sujetos (58,9%), y la presión positiva continua en la vía aérea en 41 (38,3%). No se encontraron diferencias entre ellas. Conclusión. Aproximadamente cuatro de cada cinco pacientes tratados con TRNI sobrevivieron a los 90 días, y no se encontraron diferencias significativas entre la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea.S