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Varón-Vega F, Rincón A, Giraldo-Cadavid LF, Tuta-Quintero E, Palacios J, Crevoisier S, Duarte DC, Poveda M, Cucunubo L, Monedero P. Assessing the reproducibility and predictive value of objective cough measurement for successful withdrawal of invasive ventilatory support in adult patients. BMC Pulm Med 2024; 24:218. [PMID: 38698348 PMCID: PMC11067300 DOI: 10.1186/s12890-024-03033-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Utilizing clinical tests, such as objective cough measurement, can assist in predicting the success of the weaning process in critically ill patients. METHODS A multicenter observational analytical study was conducted within a prospective cohort of patients recruited to participate in COBRE-US. We assessed the capability of objective cough measurement to predict the success of the spontaneous breathing trial (SBT) and extubation. Intra- and inter-observer reproducibility of the cough test and was evaluated using the intraclass correlation coefficient (ICC) and Cohen's weighted kappa. We used receiver operating characteristic curves (ROC-curve) to evaluate the predictive ability of objective cough measurement. RESULTS We recruited 367 subjects who were receiving invasive mechanical ventilation. A total of 451 objective cough measurements and 456 SBTs were conducted. A significant association was found between objective cough measurement and successful SBT (OR: 1.68; 95% CI 1.48-1.90; p = 0.001). The predictive capability of the objective cough test for SBT success had a ROC-curve of 0.58 (95% CI: 0.56-0.61). Objective cough measurement to predict successful extubation had a ROC-curve of 0.61 (95% CI: 0.56-0.66). The intraobserver reproducibility exhibited an ICC of 0.94 (95% CI: 0.89-0.96; p < 0.001), while the interobserver reproducibility demonstrated an ICC of 0.72 (95% CI: 0.51-0.85; p < 0.001). The intraobserver agreement, assessed using Cohen's weighted kappa was 0.94 (95% CI: 0.93-0.99; p < 0.001), whereas the interobserver agreement was 0.84 (95% CI: 0.67 - 0.10; p < 0.001). CONCLUSIONS The objective measurement of cough using the method employed in our study demonstrates nearly perfect intra-observer reproducibility and agreement. However, its ability to predict success or failure in the weaning process is limited.
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Affiliation(s)
- Fabio Varón-Vega
- Critical Care and Lung transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, Colombia.
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13b #161 - 85., Bogotá, 110131, Colombia.
| | - Adriana Rincón
- Critical Care and Lung transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, Colombia
- Master's Candidate in Epidemiology, Universidad de La Sabana, Chía, Colombia
| | - Luis F Giraldo-Cadavid
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
- Interventional Pulmonology Service, Fundación Neumológica Colombiana, Bogotá, Colombia
| | | | - Jonathan Palacios
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13b #161 - 85., Bogotá, 110131, Colombia
| | - Stephanie Crevoisier
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13b #161 - 85., Bogotá, 110131, Colombia
| | - Diana C Duarte
- Critical Care and Lung transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, Colombia
| | - Marcela Poveda
- Critical Care Service, Fundación Clínica Shaio, Bogotá, Colombia
| | - Laura Cucunubo
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13b #161 - 85., Bogotá, 110131, Colombia
| | - Pablo Monedero
- School of Medicine, Universidad de Navarra, Pamplona, España
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Giraldo-Montoya ÁM, Torres-Duque CA, Giraldo-Cadavid LF, Laucho-Contreras ME, González-Flórez A, Santos AM, Tuta-Quintero EA, Celli BR, González-García M. Sputum Biomarkers in Wood and Tobacco Smoke Etiotypes of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 19:1-10. [PMID: 38179428 PMCID: PMC10763680 DOI: 10.2147/copd.s439064] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction There is a need to better understand the etiotypes of chronic obstructive pulmonary disease (COPD) beyond the tobacco-smoke (TS-COPD). Wood smoke COPD (WS-COPD) is characterized by greater airway compromise, milder emphysema, and slower rate of lung function decline than TS-COPD. However, it is unclear if these two etiotypes of COPD have differences in sputum biomarker concentrations. Objective was to compare sputum levels of selected sputum biomarkers between WS-COPD and TS-COPD, and healthy controls. Methods Eighty-eight women (69±12 years) were recruited and classified into: WS-COPD (n=31), TS-COPD (n=29) and controls (n=28). Using ELISA, we determined induced sputum levels of metalloproteinase 9 (MMP-9), chemokine ligand 5 (CCL5), interleukin-8 (IL-8), chemokine ligand 16 (CCL16/HCC-4) and vascular endothelial growth factor (VEGF-1). Differences were analyzed by Kruskal-Wallis and Mann-Whitney-U tests and correlation between airflow limitation and biomarkers by Spearman's test. Results At similar degree of airflow obstruction, anthropometrics and medications use, the level of sputum CCL5 was higher in TS-COPD than WS-COPD (p=0.03) without differences in MMP-9, IL-8, CCL16/HCC-4, and VEGF-1. Women with WS-COPD and TS-COPD showed significantly higher sputum levels of MMP-9, IL-8 and CCL5 compared with controls (p<0.001). FEV1% predicted correlated negatively with levels of MMP-9 (rho:-0.26; P=0.016), CCL5 (rho:-0.37; P=0.001), IL-8 (rho:-0.42; P<0.001) and VEGF (rho:-0.22; P=0.04). Conclusion While sputum concentrations of MMP-9, IL-8, and CCL5 were higher in COPD women compared with controls, women with TS-COPD had higher levels of CCL5 compared with those with WS-COPD. Whether this finding relates to differences in pathobiological pathways remains to be determined.
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Affiliation(s)
- Ángela María Giraldo-Montoya
- CINEUMO, Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- School of Medicine, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Carlos A Torres-Duque
- CINEUMO, Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Biosciences Doctoral, Universidad de La Sabana, Chía, Colombia
| | - Luis F Giraldo-Cadavid
- Medical Department, Fundación Neumológica Colombiana, Bogotá, Colombia
- Epidemiology and Biostatistics Department, Universidad de La Sabana, Chía, Colombia
| | | | | | | | - Eduardo A Tuta-Quintero
- CINEUMO, Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Epidemiology and Biostatistics Department, Universidad de La Sabana, Chía, Colombia
| | | | - Mauricio González-García
- CINEUMO, Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- School of Medicine, Universidad de La Sabana, Chía, Colombia
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Ramos-Isaza E, Tuta-Quintero E, Bastidas-Goyes A, Diaz-Quijano D, Aponte-Murcia C, Espitia-Angel J, Pinto-Beltran D, Rincón-Hernández J, Sánchez-Cuellar J, Pérez-Bueno J, Giraldo-Cadavid LF. Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin - propensity score matching study. BMC Pharmacol Toxicol 2023; 24:77. [PMID: 38093310 PMCID: PMC10720047 DOI: 10.1186/s40360-023-00712-8] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Venous thromboembolic disease (VTE) is characterized by obstruction of venous blood flow by a thrombus. Survival data, frequency of disease recurrence, and bleeding rate in patients on anticoagulant therapy with warfarin compared to rivaroxaban in the Latin American population are limited in VTE. METHODS A retrospective cohort study with propensity score matching analysis was conducted in patients with pulmonary embolism and/or deep vein thrombosis anticoagulated with warfarin or rivaroxaban treated. Survival analysis was performed using a Kaplan-Meier curve for each of the intervention groups, and it was compared using a Log Rank test. RESULTS Of 2193 potentially eligible patients with a suspected diagnosis of VTE, 505 patients entered the analysis; of these, 285 subjects were managed with warfarin and 220 anticoagulated with rivaroxaban. Major bleeding at 12 months occurred in 2.7% (6/220) of patients treated with Rivaroxaban, compared to 10.2% (29/285) in the Warfarin group in the unmatched population (p = 0.001). In the matched population, bleeding at 12 months occurred in 2.9% (6/209) of patients on Rivaroxaban and in 11.0% (23/209) of patients on Warfarin (p = 0.001). The survival rates at 6 months were 97.1% for Rivaroxaban and 97.6% for Warfarin (p = 0.76). At 12 months, the survival rates were 94.7% for Rivaroxaban and 95.7% for Warfarin (p = 0.61). CONCLUSION In the treatment of VTE, there is no differences on 6 and 12-month survival or a reduction in the occurrence of new thromboembolic events when comparing rivaroxaban to warfarin. However, a lower risk of major bleeding is observed at 12 months with Rivaroxaban.
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Affiliation(s)
- Estefan Ramos-Isaza
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | - Eduardo Tuta-Quintero
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | - Alirio Bastidas-Goyes
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia.
| | - Diana Diaz-Quijano
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | | | - Julian Espitia-Angel
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | - Daniel Pinto-Beltran
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | - Johan Rincón-Hernández
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | - Juan Sánchez-Cuellar
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | - Jesus Pérez-Bueno
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
| | - Luis F Giraldo-Cadavid
- Medicine at Facultad de Medicina, Universidad de La Sabana, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia
- Chief of the Interventional Pulmonology Service, Facultad de Medicina, Fundacion Neumologica Colombiana, Universidad de La Sabana, Bogotá, Colombia
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Flandes J, Martinez-Muñiz FB, Cruz-Rueda JJ, Soto FJ, Majid A, Tuta-Quintero E, Giraldo-Cadavid LF. The effect of combining different sampling tools on the performance of electromagnetic navigational bronchoscopy for the evaluation of peripheral lung lesions and factors associated with its diagnostic yield. BMC Pulm Med 2023; 23:432. [PMID: 37940942 PMCID: PMC10634141 DOI: 10.1186/s12890-023-02711-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND We assessed the performance of Electromagnetic navigational bronchoscopy (ENB) as a standalone diagnostic technique and the performance of different sampling tools used during the procedure. METHODS We recruited 160 consecutive patients who underwent ENB for peripheral lung lesions (PLL) at a tertiary care centre. The diagnostic performance of ENB and sampling tools was assessed using a logistic regression model and a ROC-curve in which the dependent variable was diagnostic success. A multivariate model was built to predict diagnostic success before performing ENB to select the best candidates for the procedure. RESULTS Most patients with PLLs in the study were male (65%), with a mean age of 67.9 years. The yield was 66% when the most common techniques were used together as suction catheter + transbronchial biopsy forceps (TBBx) + bronchoalveolar lavage + bronchial washing (p < 0.001) and increased to 69% when transbronchial needle aspiration (TBNA) and cytology brush were added (p < 0.001). Adding diagnostic techniques such as TBBx and TBNA resulted in an increase in diagnostic performance, with a statistically significant trend (p = 0.002). The logistic model area-under the ROC-curve for diagnostic success during ENB was 0.83 (95% CI:0.75-0.90; p < 0.001), and a logit value ≥ 0.12 was associated with ≥ 50% probability of diagnostic success. CONCLUSIONS ENB, as a stand-alone diagnostic tool for the evaluation of PLLs when performed by experienced operators using a multi-modality technique, has a good diagnostic yield. The probability of having a diagnostic ENB could be assessed using the proposed model.
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Affiliation(s)
- Javier Flandes
- Chief of Bronchology and Interventional Pulmonology Unit, IIS-Fundación Jiménez Díaz, CIBERES, Avenida Reyes Catolicos No 2, 28040, Madrid, Spain
| | | | | | - Francisco J Soto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Luis F Giraldo-Cadavid
- Professor of Medicine at Facultad de Medicina, Autonorte de Bogota. Chía, Universidad de La Sabana. Address: Universidad de La Sabana, Km 7, 250001, Cundinamarca, Colombia.
- Chief of the Interventional Pulmonology Service at Fundacion Neumologica Colombiana, Cra. 13B#161 - 85, 110131, Bogotá, Colombia.
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Varón-Vega F, Giraldo-Cadavid LF, Uribe AM, Rincón A, Palacios J, Crevoisier S, Tuta-Quintero E, Ordoñez L, Boada N, Rincón P, Poveda M, Monedero P. Utilization of spontaneous breathing trial, objective cough test, and diaphragmatic ultrasound results to predict extubation success: COBRE-US trial. Crit Care 2023; 27:414. [PMID: 37908002 PMCID: PMC10617213 DOI: 10.1186/s13054-023-04708-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The results of clinical and weaning readiness tests and the spontaneous breathing trial (SBT) are used to predict the success of the weaning process and extubation. METHODS We evaluated the capacity of the cuff leak test, rate of rapid and shallow breathing, cough intensity, and diaphragmatic contraction velocity (DCV) to predict the success of the SBT and extubation in a prospective, multicenter observational study with consecutive adult patients admitted to four intensive care units. We used receiver operating characteristic (ROC) curves to assess the tests' predictive capacity and built predictive models using logistic regression. RESULTS We recruited 367 subjects who were receiving invasive mechanical ventilation and on whom 456 SBTs were performed, with a success rate of 76.5%. To predict the success of the SBT, we derived the following equation: (0.56 × Cough) - (0.13 × DCV) + 0.25. When the cutoff point was ≥ 0.83, the sensitivity was 91.5%, the specificity was 22.1%, and the overall accuracy was 76.2%. The area under the ROC curve (AUC-ROC) was 0.63. To predict extubation success, we derived the following equation: (5.7 × SBT) + (0.75 × Cough) - (0.25 × DCV) - 4.5. When the cutoff point was ≥ 1.25, the sensitivity was 96.8%, the specificity was 78.4%, and the overall accuracy was 91.5%. The AUC-ROC of this model was 0.91. CONCLUSION Objective measurement of cough and diaphragmatic contraction velocity could be used to predict SBT success. The equation for predicting successful extubation, which includes SBT, cough, and diaphragmatic contraction velocity values, showed excellent discriminative capacity.
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Affiliation(s)
- Fabio Varón-Vega
- Critical Care and Lung Transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, Colombia.
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia.
| | - Luis F Giraldo-Cadavid
- Interventional Pulmonology Service, Fundación Neumológica Colombiana, Bogotá, Colombia
- School of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Ana María Uribe
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | - Adriana Rincón
- Critical Care and Lung Transplantation Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Bogotá, Colombia
| | - Jonathan Palacios
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | - Stephanie Crevoisier
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | | | - Lina Ordoñez
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
| | - Natalia Boada
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
- Critical Care Service, Fundación Clínica Shaio, Bogotá, Colombia
| | - Paola Rincón
- Critical Care Service, Fundación Neumológica Colombiana, Fundación Cardio Infantil, Cra. 13B #161 - 85, 110131, Bogotá, Colombia
- Critical Care Service, Fundación Clínica Shaio, Bogotá, Colombia
| | - Marcela Poveda
- Critical Care Service, Fundación Clínica Shaio, Bogotá, Colombia
| | - Pablo Monedero
- School of Medicine, Universidad de Navarra, Pamplona, Spain
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Maldonado-Franco A, Giraldo-Cadavid LF, Tuta-Quintero E, Bastidas Goyes AR, Botero-Rosas DA. The Challenges of Spirometric Diagnosis of COPD. Can Respir J 2023; 2023:6991493. [PMID: 37808623 PMCID: PMC10558269 DOI: 10.1155/2023/6991493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 10/10/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the top causes of morbidity and mortality worldwide. Although for many years its accurate diagnosis has been a focus of intense research, it is still challenging. Due to its simplicity, portability, and low cost, spirometry has been established as the main tool to detect this condition, but its flawed performance makes it an imperfect COPD diagnosis gold standard. This review aims to provide an up-to-date literature overview of recent studies regarding COPD diagnosis; we seek to identify their limitations and establish perspectives for spirometric diagnosis of COPD in the XXI century by combining deep clinical knowledge of the disease with advanced computer analysis techniques.
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Affiliation(s)
| | - Luis F. Giraldo-Cadavid
- Departments of Epidemiology and Internal Medicine, School of Medicine, Universidad de La Sabana, Chía, Colombia
- Director of Interventional Pulmonology Service, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Eduardo Tuta-Quintero
- Candidate for Master's Degree in Epidemiology, Universidad de La Sabana, Chía, Colombia
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Duenas-Meza E, Giraldo-Cadavid LF, Karpf E, Afanador F, Angarita OL, Barón O, Medina MS, Pachón A, Gonzalez A, Jurado J, Torres-Duque CA. Cost-utility analysis of an integrated care program for children with asthma in a medium-income country. Pediatr Pulmonol 2020; 55:3110-3118. [PMID: 33460317 DOI: 10.1002/ppul.24996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the cost-utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for children with asthma compared with standard of care. METHODS A decision-analytic model was used to compare an integrated care program compared to the standard of care in children with asthma in Bogota, Colombia. Baseline characteristics of the patients were established according to the distribution of patients in the PAI database. Other inputs were obtained from published meta-analysis, local registries, medical bills, general mortality data, and expert opinion. Costs were presented in 2017 Colombian pesos. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 5% per year. Incremental cost-utility ratios were presented for PAI compared with standard of care. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty. RESULTS The model predicted that patients that are part of the PAI would accrue more QALYs than patients on standard of care. The incremental results suggest that the PAI is a cost-effective treatment (incremental cost-utility ratio of Colombian pesos $33 753 817/QALY) compared with standard of care. Sensitivity analyses suggest that results are most sensitive to cost of care (with and without PAI) and costs of severe exacerbation. However, the PAI is cost-effective irrespective of variation in any of the input parameters. CONCLUSION Our model predicted that an integrated intervention for the management of asthma in pediatric patients improves QALYs, reduces number of disease related exacerbations compared to standard therapy and is cost-effective for the long-term control of the disease in Colombia.
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Affiliation(s)
- Elida Duenas-Meza
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Luis F Giraldo-Cadavid
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Epidemiology and Biostatistics, School of Medicine, University of La Sabana, Bogotá, Colombia
| | | | | | | | - Oscar Barón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Maria S Medina
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Angelica Pachón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Angelica Gonzalez
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Jenny Jurado
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Carlos A Torres-Duque
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,School of Medicine, University of La Sabana, Bogotá, Colombia
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Varón-Vega F, Hernández Á, López M, Cáceres E, Giraldo-Cadavid LF, Uribe-Hernandez AM, Crevoisier S. [Usefulness of diaphragmatic ultrasound in predicting extubation success]. Med Intensiva 2019; 45:226-233. [PMID: 31870509 DOI: 10.1016/j.medin.2019.10.007] [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: 07/22/2019] [Revised: 09/16/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success. DESIGN A diagnostic accuracy study was carried out. SCOPE Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia). PATIENTS OR PARTICIPANTS A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h. INTERVENTIONS Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing. MAIN VARIABLES OF INTEREST Diaphragmatic excursion (DE, cm), inspiration time (TPIAdia, s), diaphragm contraction speed (DE/TPIAdia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TFdi, %). RESULTS A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008). CONCLUSIONS Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process.
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Affiliation(s)
- F Varón-Vega
- Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia; Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia; Departamento de Anestesiología y Cuidados Intensivos, Universidad de Navarra, Pamplona, España
| | - Á Hernández
- Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - M López
- Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - E Cáceres
- Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - L F Giraldo-Cadavid
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia; Departamento de Epidemiología y de Medicina Interna, Universidad de La Sabana, Chía, Colombia
| | - A M Uribe-Hernandez
- Unidad de Cuidado Intensivo Médico, Fundación Neumológica Colombiana, Bogotá, Colombia; Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia; Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia.
| | - S Crevoisier
- Medicina Crítica y Cuidado Intensivo, Universidad de La Sabana, Chía, Colombia
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9
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Giraldo-Cadavid LF, Pantoja JA, Forero YJ, Gutiérrez HM, Bastidas AR. Aspiration in the Fiberoptic Endoscopic Evaluation of Swallowing Associated with an Increased Risk of Mortality in a Cohort of Patients Suspected of Oropharyngeal Dysphagia. Dysphagia 2019; 35:369-377. [PMID: 31327077 DOI: 10.1007/s00455-019-10036-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/30/2018] [Revised: 06/08/2019] [Accepted: 07/09/2019] [Indexed: 01/06/2023]
Abstract
There is a general lack of published studies on the risk of mortality due to alterations in the safety of swallowing detected during the fiberoptic endoscopic evaluation of swallowing (FEES). We aimed at assessing the risk of mortality of the detection of aspiration, penetration, and pharyngeal residues by FEES. A cohort of consecutively evaluated patients suspected of experiencing oropharyngeal dysphagia undergoing FEES at a tertiary care university hospital were prospectively followed up on to assess mortality. The FEES findings, comorbidities, and potential confounders were studied as predictors of death using a Cox multivariate regression analysis. A total of 148 patients were included, 85 of whom were male (57.4%). The mean age (± standard deviation) was 52.7 years (± 22.1). The median of the follow-up time was 4.5 years. The most frequent conditions were stroke in 50 patients (33.8%), brain and spine traumas in 27 (18.2%), and neurodegenerative diseases in 19 (12.8%). Variables associated with mortality in bivariate analyses were age > 65 years (p < 0.001), pneumonia (p = 0.046), aspiration of any consistency (p < 0.001), and pharyngeal residues (p = 0.017). Variables independently associated with mortality in the Cox multivariate model were age (> 65 years) [adjusted hazard ratio (HR) 5.76; 95% CI 2.72 to 17.19; p = 0.001] and aspiration (adjusted HR: 3.96; 95% CI 1.82 to 14.64; p = 0.003). Aspiration detected by FEES and an age > 65 years are independent predictors of mortality in patients with oropharyngeal dysphagia.
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Affiliation(s)
- Luis F Giraldo-Cadavid
- Departments of Epidemiology and Internal Medicine, Facultad de Medicina de la Universidad de La Sabana, Universidad de La Sabana School of Medicine, Campus Puente del Común, Autopista norte de Bogotá Km 7, Chía, Cundinamarca, Colombia. .,Interventional Pulmonology Division, Fundación Neumológica Colombiana, Bogotá, DC, Colombia.
| | - Jaime A Pantoja
- PGY-2 at the Clinical Pharmacology Department, Universidad de La Sabana School of Medicine, Chía, Colombia
| | - Yency J Forero
- PGY-3 at the Internal Medicine Department, Universidad de La Sabana School of Medicine, Chía, Colombia
| | - Hilda M Gutiérrez
- PGY-3 at the Internal Medicine Department, Universidad de La Sabana School of Medicine, Chía, Colombia
| | - Alirio R Bastidas
- Department of Internal Medicine and Research, Universidad de La Sabana School of Medicine, Chía, Colombia
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10
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Duenas-Meza E, Torres-Duque CA, Correa-Vera E, Suárez M, Vásquez C, Jurado J, Del Socorro Medina M, Barón O, Pareja-Zabala MJ, Giraldo-Cadavid LF. High prevalence of house dust mite sensitization in children with severe asthma living at high altitude in a tropical country. Pediatr Pulmonol 2018; 53:1356-1361. [PMID: 29938928 DOI: 10.1002/ppul.24079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/06/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Some studies, mainly in Europe, have shown a low level of sensitization to house dust mite (HDM) allergens at high altitude (HA). Differently, some others in tropical countries have shown a higher level. The aim of this study was to evaluate allergens sensitization, including HDM, in children with severe asthma (SA), residents at HA in a tropical middle-income developing country. METHODS Observational, analytical, cross-sectional study in children aged 6-15 years old with SA at HA (2640 m). Skin prick tests (SPT), serum IgE, exhaled fraction of nitric oxide (FENO ), spirometry, and asthma questionnaire (ACT) were performed. Associations were explored by Pearson or Spearman coefficients. RESULTS We included 61 children. Most patients were male (61.3%), median age: 10 years (Interquartile range [IQR]: 8-12), median BMI: 17 kg/m2 (IQR: 16-20); Median of positive SPT: 2 (IQR: 2-3). At least one SPT was positive in 88.7% of patients and 87.9% were positive for at least one HDM. Serum IgE: 348 UI/mL (IQR: 154-760) and FENO : 22 ppb (IQR: 9-41). Prebronchodilator values were (% predicted): FVC: 109.7% (±15.5%), FEV1 : 98.4% (±16.3); FEV1 /FVC: 82% (±8%). SPT were inversely correlated with the FEV1 /FVC (Rho: -0.34; 95% CI: -0.55 a -0.09; P = 0.008). CONCLUSIONS These children with SA living at HA in a tropical middle-income developing country have a high prevalence of HDM sensitization. One explanation for this might be that tropical conditions, such as temperature and humidity, could modify the effect of the altitude on asthma.
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Affiliation(s)
- Elida Duenas-Meza
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia.,Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | - Carlos A Torres-Duque
- Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | | | - Miguel Suárez
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Catalina Vásquez
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Jenny Jurado
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | | | - Oscar Barón
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - María J Pareja-Zabala
- Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | - Luis F Giraldo-Cadavid
- Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
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11
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Giraldo-Cadavid LF, Agudelo-Otalora LM, Burguete J, Arbulu M, Moscoso WD, Martínez F, Ortiz AF, Diaz J, Pantoja JA, Rueda-Arango AF, Fernández S. Design, development and validation of a new laryngo-pharyngeal endoscopic esthesiometer and range-finder based on the assessment of air-pulse variability determinants. Biomed Eng Online 2016; 15:52. [PMID: 27160751 PMCID: PMC4862145 DOI: 10.1186/s12938-016-0166-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/28/2016] [Indexed: 12/02/2022] Open
Abstract
Background Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because it assesses only the laryngeal adductor reflex during fiber-optic endoscopic evaluations of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity. Methods We designed, developed and validated a new air-pulse laryngo-pharyngeal endoscopic esthesiometer with a built-in laser range-finder (LPEER) based on the evaluation and control of air-pulse variability determinants and on intrinsic observer variability and subjectivity determinants of the distance, angle and site of stimulus impact. The LPEER was designed to be capable of delivering precise and accurate stimuli with a wide range of intensities that can explore most laryngo-pharyngeal reflexes. Results We initially explored the potential factors affecting the reliability of LPMS tests and included these factors in a multiple linear regression model. The following factors significantly affected the precision and accuracy of the test (P < 0.001): the tube conducting the air-pulses, the supply pressure of the system, the duration of the air-pulses, and the distance and angle between the end of the tube conducting the air-pulses and the site of impact. To control all of these factors, an LPEER consisting of an air-pulse generator and an endoscopic laser range-finder was designed and manufactured. We assessed the precision and accuracy of the LPEER’s stimulus and range-finder according to the coefficient of variation (CV) and by looking at the differences between the measured properties and the desired values, and we performed a pilot validation on ten human subjects. The air-pulses and range-finder exhibited good precision and accuracy (CV < 0.06), with differences between the desired and measured properties at <3 % and a range-finder measurement error of <1 mm. The tests in patients demonstrated obtainable and reproducible thresholds for the laryngeal adductor, cough and gag reflexes. Conclusions The new LPEER was capable of delivering precise and accurate stimuli for exploring laryngo-pharyngeal reflexes.
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Affiliation(s)
- Luis F Giraldo-Cadavid
- School of Medicine, University of Navarra, Irunlarea 1, 31080, Pamplona, Navarra, Spain. .,School of Medicine, University of La Sabana, Autonorte de Bogotá, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia.
| | - Luis Mauricio Agudelo-Otalora
- School of Engineering, University of La Sabana, Autonorte de Bogota, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia
| | - Javier Burguete
- School of Sciences, University of Navarra, Irunlarea 1, 31080, Pamplona, Navarra, Spain
| | - Mario Arbulu
- School of Engineering, University of La Sabana, Autonorte de Bogota, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia
| | - William Daniel Moscoso
- School of Engineering, University of La Sabana, Autonorte de Bogota, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia
| | - Fabio Martínez
- School of Engineering, University of La Sabana, Autonorte de Bogota, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia
| | - Andrés Felipe Ortiz
- Statistical Consulting Office, University of Santo Tomas, Carrera 9 # 51-11, Bogota, Colombia
| | - Juan Diaz
- School of Engineering, University of La Sabana, Autonorte de Bogota, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia
| | - Jaime A Pantoja
- Departamento de Medicina Interna, School of Medicine, University of La Sabana, Autonorte de Bogota, Km 7, Campus Puente del Comun, Chia, 250001, Cundinamarca, Colombia
| | - Andrés Felipe Rueda-Arango
- School of Engineering, University of La Sabana, Autonorte de Bogota, Km 7, Campus Puente del Común, Chia, 250001, Cundinamarca, Colombia
| | - Secundino Fernández
- School of Medicine, University of Navarra, Irunlarea 1, 31080, Pamplona, Navarra, Spain
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