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Arias CF, Herraiz EB, Clemente CC, Mezalek RT, Garcia FA, Capa JA, Gratacós AR, Mitjà PS. Usefulness of routine bronchial aspirate of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Arch Bronconeumol 2023:S0300-2896(23)00120-5. [PMID: 37061440 DOI: 10.1016/j.arbres.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used for the study of intrathoracic lymphadenopathy and centrally tumours but no report has discussed the contribution of routine cytological and microbiological BA during the procedure. The aim of the study was to analyse the diagnostic yield of BA during EBUS, and to determine the potential cost reduction. METHODS A prospective study of cytological and microbiological BA collected during EBUS-TBNA was conducted between January 2021 and June 2022. Demographic data, indication, previous BA bronchoscopy or EBUS diagnosis were recorded. The main variable tested was the number of patients in which the result of the BA obtained through EBUS-TBNA determined a change in the diagnosis. RESULTS A total of 450 (70.9% male) patients were included. BA cytology showed abnormal cells in 33 (7.3%) of patients, and only 1 case (0.2%) provided a previously unknown diagnosis. All these cases were patients with suspected malignancy. BA microbiological samples found germens in 30 (6.7%) patients but only in 5 cases (1.1%) found microbiological specimens not detected in previous bronchoscopy. None of them received antibiotics and evolved correctly. The potential total cost reduction during the study period at our centre if routine BA was deleted would be 21,937.50€ for routinely combined study. CONCLUSIONS The low diagnostic yield of cytological and microbiological bronchial aspirate in EBUS-TBNA supports the idea of not performing routine BA. Although the potential for cost savings in caring for an individual patient is modest, many centres routinely perform BA, so the potential savings could be significant.
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Serra Mitjà P, Gonçalves Dos Santos Carvalho F, Garcia Olivé I, Sanz Santos J, Jiménez López J, Núñez Ares A, Tomás López L, Centeno Clemente C, Tazi R, Castellà E, Abad Capa J, Rosell Gratacós A, Andreo Garcia F. Incidence and Risk Factors for Infectious Complications of EBUS-TBNA: Prospective Multicenter Study. Arch Bronconeumol 2023; 59:84-89. [PMID: 36446657 DOI: 10.1016/j.arbres.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/29/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
The aim of our study was to describe the incidence of infectious complications of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and to analyze the potential risk factors in a prospective cohort of patients. METHODS We conducted a prospective multicenter study, with all consecutive patients referred for an EBUS-TBNA with patients at risk of developing an infectious complication (considering>10 nodal samplings, known immunosuppression, bronchial colonization and cavitated or necrotic lesions) and a second group without any risk factor. RESULTS Three hundred seventy patients were included: 245 with risk factors and 125 without risk factors (as the control group). Overall, 15 patients (4.05%) presented an acute infectious complication: fourteen in cases (5.7%) and 1 in controls (0.8%). Of these, 4 patients presented pneumonia, 1 mediastinitis, 4 obstructive pneumonitis and 6 mild complications (respiratory tract infection that resolved with antibiotic). Also 7 (1.9%) patients had self-limited fever. One-month follow-up showed 1 mediastinitis at sixteenth day post-EBUS, which required surgical treatment, and 3 pneumonias and 3 respiratory tract infections at nineteenth day (1.9%). All patients had a good evolution and there were no deaths related with infectious complication. We observed an increased risk of complication in patients with risk factors and in patients with necrosis (p=0.018). CONCLUSIONS The incidence of infectious complications in a subgroup of patients with risk factors was higher than in patients without risk factors. Nevertheless, it remains low, and no fatal complication occurred, which reinforces the idea that EBUS-TBNA is a safe technique for the assessment of the mediastinum. Necrotic lesions are a risk factor of post-EBUS infection, and their puncture should be avoided.
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Affiliation(s)
- Pere Serra Mitjà
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain.
| | | | - Ignasi Garcia Olivé
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | | | | | | | | | - Carmen Centeno Clemente
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | - Rachid Tazi
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | - Eva Castellà
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge Abad Capa
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
| | - Antoni Rosell Gratacós
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
| | - Felipe Andreo Garcia
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
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Galdeano Lozano M, Alfaro Álvarez JC, Parra Macías N, Salas Campos R, Heili Frades S, Montserrat JM, Rosell Gratacós A, Abad Capa J, Parra Ordaz O, López Seguí F. Effectiveness of Intermediate Respiratory Care Units as an Alternative to Intensive Care Units during the COVID-19 Pandemic in Catalonia. Int J Environ Res Public Health 2022; 19:ijerph19106034. [PMID: 35627571 PMCID: PMC9141338 DOI: 10.3390/ijerph19106034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Objectives: During the COVID-19 pandemic, the risk of collapse for the health system created great difficulties. We will demonstrate that intermediate respiratory care units (IRCU) provide adequate management of patients with non-invasive respiratory support, which is particularly important for patients with SARS-CoV-2 pneumonia. Methods: A prospective observational study of patients with COVID-19 admitted to the ICU of a tertiary hospital. Sociodemographic data, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was subsequently analyzed. Results: 991 patients were admitted, 56 to the IRCU (from a of 81 admitted to the critical care unit). Mean age was 65 years (SD 12.8), Barthel index 75 (SD 8.3), Charlson comorbidity index 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. A significant relationship (p < 0.05) with higher mortality was noted for the following parameters: fever greater than or equal to 39 °C [OR 5.6; 95% CI (1.2−2.7); p = 0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1−0.9); p = 0.023] and IOI [OR 3.7; 95% CI (1.1−12.3); p = 0.025]. NIMV had less of a negative impact [OR 1.8; 95% CI (0.4−8.4); p = 0.423] than IOI. The total cost of the IRCU amounted to €66,233. The cost per day of stay in the IRCU was €164 per patient. The total cost avoided was €214,865. Conclusions: The pandemic has highlighted the importance of IRCUs in facilitating the management of a high patient volume. The treatment carried out in IRCUs is effective and efficient, reducing both admissions to and stays in the ICU.
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Affiliation(s)
- Marina Galdeano Lozano
- Unidad de Ventilación y Cuidados Respiratorios Intermedios, Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, Reseau Europén de Recherche en Ventilation Artificielle (REVA), 08193 Barcelona, Spain
- Unidad de Economía de la Salud, Dirección de Innovación de la Gerencia Territorial Metropolitana Norte, Institut Català de la Salut, 08007 Barcelona, Spain;
- Doctorat de Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, 08193 Barcelona, Spain;
- Correspondence: ; Tel.: +34-934661200 (ext. 3603)
| | | | - Núria Parra Macías
- Unidad de Innovación Clínica y Promoción de la Salud, Hospital Universitario Sagrat Cor, Grupo Quirón Salud, 08029 Barcelona, Spain;
| | - Rosario Salas Campos
- Servicio de Medicina Interna, Hospital Universitario Sagrat Cor, Quirón Salud, 08029 Barcelona, Spain;
| | - Sarah Heili Frades
- Unidad de Cuidados Intermedios Respiratorios, Hospital Fundación Jimenez Díaz, Grupo Quirón Salud, Reseau Europén de Recherche en Ventilation Artificielle, 28040 Madrid, Spain;
| | - Josep Maria Montserrat
- Unidad del Sueño, Servicio de Neumología, Hospital Clínic Provincial Barcelona, Universitat de Barcelona, 08193 Barcelona, Spain;
| | - Antoni Rosell Gratacós
- Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain; (A.R.G.); (J.A.C.)
| | - Jorge Abad Capa
- Servicio de Neumología, Direcció Clínica Àrea del Tórax, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain; (A.R.G.); (J.A.C.)
| | - Olga Parra Ordaz
- Doctorat de Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, 08193 Barcelona, Spain;
- Unidad de Sueño Servicio de Neumología, Hospital Universitario Sagrat Cor, Quirón Salud, 08029 Barcelona, Spain
| | - Francesc López Seguí
- Unidad de Economía de la Salud, Dirección de Innovación de la Gerencia Territorial Metropolitana Norte, Institut Català de la Salut, 08007 Barcelona, Spain;
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Andreo García F, Torky M, Centeno Clemente C, Serra Mitjà P, Rosell Gratacós A, Tazi Mezalek R. Transbronchial Cryobiopsy of Peripheral Pulmonary Lesions Guided With Real-Time Transthoracic Ultrasonography. Arch Bronconeumol 2021; 57:772-774. [PMID: 35698989 DOI: 10.1016/j.arbr.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/20/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Felipe Andreo García
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain.
| | - Mohamed Torky
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Chest Department, Tanta University, Egypt
| | - Carmen Centeno Clemente
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pere Serra Mitjà
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Rosell Gratacós
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain
| | - Rachid Tazi Mezalek
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Andreo García F, Torky M, Centeno Clemente C, Serra Mitjà P, Rosell Gratacós A, Tazi Mezalek R. Transbronchial Cryobiopsy of Peripheral Pulmonary Lesions Guided With Real-Time Transthoracic Ultrasonography. Arch Bronconeumol 2020; 57:S0300-2896(20)30398-7. [PMID: 33358538 DOI: 10.1016/j.arbres.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Felipe Andreo García
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain.
| | - Mohamed Torky
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Chest Department, Tanta University, Egypt
| | - Carmen Centeno Clemente
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pere Serra Mitjà
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Rosell Gratacós
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain
| | - Rachid Tazi Mezalek
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Álvarez Martínez CJ, Bastarrika Alemañ G, Disdier Vicente C, Fernández Villar A, Hernández Hernández JR, Maldonado Suárez A, Moreno Mata N, Rosell Gratacós A. Normativa sobre el manejo del nódulo pulmonar solitario. Arch Bronconeumol 2014; 50:285-93. [DOI: 10.1016/j.arbres.2014.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 12/20/2022]
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Álvarez Martínez CJ, Bastarrika Alemañ G, Disdier Vicente C, Fernández Villar A, Hernández Hernández JR, Maldonado Suárez A, Moreno Mata N, Rosell Gratacós A. Guideline on Management of Solitary Pulmonary Nodule. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.arbr.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Sánchez de Cos Escuín J, Hernández Hernández J, Jiménez López M, Padrones Sánchez S, Rosell Gratacós A, Rami Porta R. Réplica. Arch Bronconeumol 2012. [DOI: 10.1016/j.arbres.2011.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Sánchez de Cos J, Hernández JH, López MFJ, Sánchez SP, Gratacós AR, Porta RR. SEPAR guidelines for lung cancer staging. Arch Bronconeumol 2011; 47:454-65. [PMID: 21824707 DOI: 10.1016/j.arbres.2011.06.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 06/27/2011] [Indexed: 11/28/2022]
Abstract
The latest tumour, lymph node and metastasis (TNM) classification by the International Association for the Study of Lung Cancer (IASLC), based on the analysis of patients from all over the world, has incorporated changes in the descriptors, especially those regarding tumor size, while proposing new group staging. A new lymph node map has also been developed with the intention of facilitating the classification of the "N" component. SEPAR recommends using this new classification. As for the procedures recommended for staging, in addition to the generalized use of computed tomography (CT), it points to the role of positron emission tomography (PET) or image fusion methods (PET/CT), which provide a better evaluation of the mediastinum and extrathoracic metastases. Endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS) for obtaining cytohistological samples have been incorporated in the staging algorithm, and it emphasizes the importance of precise re-staging after induction treatment in order to make new therapeutic decisions. Comment is made on the foreseeable incorporation in the near future of molecular staging, and systematic lymph node dissection is recommended with the intention of making a more exact surgical-pathological classification.
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Rosell Gratacós A, Ginés Gibert À, Serra Mitjans M, Gámez Cenzano C. Estadificación mediastínica del cáncer de pulmón en el siglo XXI: un reto de carácter multidisciplinario. Med Clin (Barc) 2008; 130:415-22. [DOI: 10.1157/13117859] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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