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Selki K, Demir MC, Şengüldür E, Erdem E, Güldal H, Taşdemir M, Kıcıroğlu AKF, Boğan M. Can end-tidal CO 2 measurement replace arterial partial CO 2 in emergency department respiratory distress management? Med Intensiva 2024:S2173-5727(24)00089-4. [PMID: 38692991 DOI: 10.1016/j.medine.2024.04.011] [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: 11/06/2023] [Accepted: 03/31/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To assess the feasibility of using end-tidal carbon dioxide (EtCO2) as a non-invasive substitute for partial pressure of arterial carbon dioxide (PaCO2) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO2) as an alternative to PaCO2. DESIGN Prospective cross-sectional study. SETTING Tertiary university hospital. PATIENTS OR PARTICIPANTS 97 patients presenting with acute respiratory distress to the ED. INTERVENTIONS EtCO2, arterial blood gases, and venous blood gases measured at admission (0 min), 60 min, and 120 min. MAIN VARIABLES OF INTEREST CO2 levels. RESULTS Among 97 patients (mean age: 70.93 ± 9.6 years; 60.8% male), EtCO2 > 45 mmHg at admission showed strong positive correlations with PaCO2 and PvCO2 (r = 0.844, r = 0.803; p < 0.001, respectively). Significant positive correlation was observed between 60-min EtCO2 and PaCO2 (r = 0.729; p < 0.001). Strong correlation between PaCO2 and PvCO2 at 120 min when EtCO2 > 45 mmHg (r = 0.870; p < 0.001). EtCO2 was higher in hospitalized patients compared to discharged ones. CONCLUSIONS EtCO2 appears promising as a substitute for PaCO2 in ED patients with acute respiratory distress within the initial two hours of treatment. Venous blood gas sampling offers a less invasive alternative to arterial sampling, facilitating simultaneous blood tests.
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Affiliation(s)
- Kudret Selki
- Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey
| | - Mehmet Cihat Demir
- Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey
| | - Erdinç Şengüldür
- Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey
| | - Emre Erdem
- Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey
| | - Hatice Güldal
- Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey
| | - Murat Taşdemir
- Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey
| | | | - Mustafa Boğan
- Düzce University, School of Medicine, Department of Emergency Medicine, Düzce, Turkey.
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2
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Maskin LP, Wilken M, Rodriguez Lucci F, Wisnivesky JP, Barroso F, Wainsztein N. Risk factors for respiratory failure among hospitalized patients with Guillain-Barré syndrome. Neurologia 2024; 39:36-42. [PMID: 38161071 DOI: 10.1016/j.nrleng.2023.12.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy that can lead to respiratory failure. In this study, we evaluate early clinical risk factors for respiratory failure at the time of hospital admission. METHODS We studied a retrospective cohort of patients with GBS admitted to a tertiary care center. The potential risk factors studied were sociodemographic characteristics, GBS symptoms, overall and cervical muscle weakness (Medical Research Council [MRC] scores), electromyography findings, and cerebrospinal fluid analysis findings. Unadjusted odds ratios (OR) were calculated and exact logistic regression analysis (adjusted OR) performed to assess the association between baseline risk factors and respiratory failure. RESULTS Overall, 13 of 113 (12%) patients included in the study developed respiratory failure. Unadjusted analyses showed that involvement of any cranial nerve (OR: 14.7; 95% CI, 1.8-117.1), facial palsy (OR: 17.3; 95% CI, 2.2-138.0), and bulbar weakness (OR: 10.7; 95% CI, 2.3-50.0) were associated with increased risk of respiratory failure. Lower MRC sum scores (for scores <30, OR: 14.0; 95% CI, 1.54-127.2) and neck MRC scores (for scores ≤3, OR: 21.0; 95% CI, 3.5-125.2) were associated with higher likelihood of respiratory failure. Adjusted analyses showed that presence of bulbar weakness (OR: 7.6; 95% CI, 1.3-43.0) and low neck MRC scores (scores ≤3, OR: 9.2; 95% CI, 3.5-125.2, vs scores >3) were independently associated with respiratory failure. CONCLUSIONS Bulbar and neck muscle weakness at admission are clinical predictors of increased risk of respiratory failure in patients with GBS. These findings could guide the adequate management of high-risk patients.
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Affiliation(s)
- L P Maskin
- Intensive Care Unit, FLENI, Buenos Aires, Argentina.
| | - M Wilken
- Department of Neurology, FLENI, Buenos Aires, Argentina
| | | | - J P Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine Icahn School of Medicine at Mount Sinai, NY, USA
| | - F Barroso
- Department of Neurology, FLENI, Buenos Aires, Argentina
| | - N Wainsztein
- Intensive Care Unit, FLENI, Buenos Aires, Argentina
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Barajas-Romero JS, Vásquez-Hoyos P, Pardo R, Jaramillo-Bustamante JC, Grigolli R, Monteverde-Fernández N, Gonzalez-Dambrauskas S, Jabornisky R, Cruces P, Wegner A, Díaz F, Pietroboni P. Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry. Med Intensiva 2024; 48:23-36. [PMID: 37481458 DOI: 10.1016/j.medine.2023.07.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/15/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). DESIGN Secondary analysis of a prospective cohort. SETTING PICUs in centers that are part of the LARed Network between April 2017 and January 2022. PARTICIPANTS Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. RESULTS 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). CONCLUSIONS Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.
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Affiliation(s)
| | - Pablo Vásquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Universidad Nacional de Colombia, Bogotá, Colombia; Sociedad de Cirugía de Bogota Hospital de San José, FUCS, Bogotá, Colombia.
| | - Rosalba Pardo
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Clínica Infantil de Colsubsidio, Bogotá, Colombia
| | - Juan Camilo Jaramillo-Bustamante
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital General de Medellín Luz Castro de Gutiérrez E.S.E., Medellín, Colombia
| | - Regina Grigolli
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Infantil Sabará, Sao Paulo, Brazil
| | | | - Sebastián Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Roberto Jabornisky
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Juan Pablo II, Corrientes, Argentina; Hospital Regional Olga Stucky de Rizzi, Reconquista, Argentina
| | - Pablo Cruces
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Universidad Andres Bello, Facultad de Ciencias de la Vida, Santiago, Chile
| | - Adriana Wegner
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Franco Díaz
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital El Carmen de Maipú, Dr. Luis Valentín Ferrada, Santiago, Chile; Unidad de Investigación y Epidemiología Clínica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Pietro Pietroboni
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Regional de Antofagasta, Antofagasta, Chile
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Rico Rodríguez F, Camargo Espitia DA, Mayoral Márquez A, Ruan Lin S, Martín Lorenzo MC. Anesthetic considerations in the perioperative management of the patient with Jarcho-Levin Syndrome. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:54-57. [PMID: 37678455 DOI: 10.1016/j.redare.2023.03.004] [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] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/30/2023] [Indexed: 09/09/2023]
Abstract
Jarcho-Levin syndrome is an eponym used to describe a spectrum of small thoracic skeletal dysplasias with variable involvement of vertebrae and ribs. Initially considered lethal, it is currently compatible with life in its mildest forms. Bone alterations that lead to a restrictive respiratory pattern, recurrent respiratory infections and particular phenotype, can make perioperative anesthetic management difficult. The proper assessment of the airway is of special interest because it presents predictors of a difficult airway, as well as the prevention, early diagnosis and adequate treatment of respiratory failure. We present the case of a patient with Jarcho-Levin Syndrome who underwent vertebral distraction surgery, with its most notable implications in anesthetic management.
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Affiliation(s)
- F Rico Rodríguez
- Doctorado Biomedicina, Investigación traslacional y nuevas tecnologías en salud de la Universidad de Málaga (UMA), Especialista en Medicina Familiar y Comunitaria, Residente Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain.
| | - D A Camargo Espitia
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - A Mayoral Márquez
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - S Ruan Lin
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - M C Martín Lorenzo
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
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Sellarès-Nadal J, Burgos J, Velasquez F, Martin-Gómez MT, Antón A, Romero-Herrera D, Eremiev S, Bosch-Nicolau P, Rodriguez-Pardo D, Len O, Falcó V. Impact of viral detection in patients with community-acquired pneumonia: An observational cohort study. Med Clin (Barc) 2023; 161:523-529. [PMID: 37598051 DOI: 10.1016/j.medcli.2023.07.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The presence of a respiratory virus in patients with community-acquired pneumonia (CAP) may have an impact on the bacterial etiology and clinical presentation. In this study we aimed to assess the role of viral infection in the bacterial etiology and outcomes of patients with CAP. METHODS We performed a retrospective study of all adults hospitalized with CAP between November 2017 and October 2018. Patients were classified according to the presence of viral infection. An unvaried and a multivaried analysis were performed to identify variables associated with viral infection and clinical outcomes. RESULTS Overall 590 patients were included. A microorganism was documented in 375 cases (63.5%). A viral infection was demonstrated in 118 (20%). The main pathogens were Streptococcus pneumoniae (35.8%), Staphylococcus aureus (2.9%) and influenza virus (10.8%). A trend to a higher rate of S. aureus (p=0.06) in patients with viral infection was observed. Patients with viral infection had more often bilateral consolidation patterns (17.8% vs 10.8%, p=0.04), respiratory failure (59.3% vs 42.8%, p=0.001), ICU admission (17.8% vs 7%, p=0.001) and invasive mechanical ventilation (9.3% vs 2.8%, p=0.003). Risk factors for respiratory failure were chronic lung disease, age >65 years, positive blood cultures and viral infection. Influenza, virus but no other respiratory viruses, was associated with respiratory failure (OR, 3.72; 95% CI, 2.06-6.73). CONCLUSIONS Our study reinforces the idea that co-viral infection has an impact in the clinical presentation of CAP causing a more severe clinical picture. This impact seems to be mainly due to influenza virus infection.
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Affiliation(s)
- Julia Sellarès-Nadal
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain; Malalties Infeccioses Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Joaquin Burgos
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain.
| | - Fernando Velasquez
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | | | - Andrés Antón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Dani Romero-Herrera
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Simeón Eremiev
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Pau Bosch-Nicolau
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Dolors Rodriguez-Pardo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Oscar Len
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Vicenç Falcó
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
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Cattin L, Ferrari F, Mongodi S, Pariani E, Bettini G, Daverio F, Donadello K, Polati E, Mojoli F, Danzi V, De Rosa S. Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study. Med Intensiva 2023; 47:131-139. [PMID: 36155747 PMCID: PMC9359672 DOI: 10.1016/j.medine.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/21/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest. SETTING Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021. PATIENTS Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management. INTERVENTIONS Endotracheal Intubation Adverse Events. MAIN VARIABLES OF INTERESTS The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest. RESULTS Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest. CONCLUSION In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent. CLINICAL TRIAL REGISTRATION www. CLINICALTRIALS gov identifier: NCT04909476.
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Affiliation(s)
- L Cattin
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy; Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - F Ferrari
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Mongodi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Pariani
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - G Bettini
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - F Daverio
- Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - K Donadello
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - E Polati
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - F Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
| | - V Danzi
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy
| | - S De Rosa
- Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy.
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Sánchez-García AM, Martínez-López P, Gómez-González AM, Rodriguez-Capitán J, Jiménez-López RJ, García Almeida JM, Avanesi-Molina E, Zamboschi N, Rueda-Molina C, Doncel-Abad V, Molina-Ramos AI, Cabrera-César E, Ben-Abdellatif I, Gordillo-Resina M, Pérez-Mesa E, Nieto-González M, Nuevo-Ortega P, Reina-Artacho C, Sánchez Fernández PL, Jiménez-Navarro MF, Estecha-Foncea MA. Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care? Med Intensiva 2022:S2173-5727(22)00348-4. [PMID: 36621347 DOI: 10.1016/j.medine.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN Cohort, prospective and observational study. SETTING Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.
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8
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Mireles-Cabodevila E. How do I ventilate patients with ARDS: Goal-directed mode selection. Med Intensiva 2022; 46:711-715. [PMID: 36220727 DOI: 10.1016/j.medine.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 06/16/2023]
Affiliation(s)
- E Mireles-Cabodevila
- Medical Intensive Care Unit, Respiratory Institute, Cleveland Clinic, Ohio, United States; Simulation and Advanced Skills Center, Education Institute, Cleveland Clinic, Ohio, United States; Cleveland Clinic Lerner College of Medicine of Case Western Reserve, Cleveland Clinic, Ohio, United States.
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Ortiz G, Bastidas A, Garay-Fernández M, Lara A, Benavides M, Rocha E, Buitrago A, Díaz G, Ordóñez J, Reyes LF. Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level. Med Intensiva 2022; 46:501-507. [PMID: 36057441 DOI: 10.1016/j.medine.2021.05.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/04/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN Ambispective descriptive multicenter cohort study. SETTING Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS None. VARIABLES Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.
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Affiliation(s)
- G Ortiz
- Pulmonary Medicine, Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Bastidas
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia.
| | - M Garay-Fernández
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Lara
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - M Benavides
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - E Rocha
- Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Buitrago
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - G Díaz
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - J Ordóñez
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - L F Reyes
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia
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Zarragoikoetxea I, Pajares A, Moreno I, Porta J, Koller T, Cegarra V, Gonzalez AI, Eiras M, Sandoval E, Aurelio Sarralde J, Quintana-Villamandos B, Vicente Guillén R. SEDAR/SECCE ECMO management consensus document. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:443-471. [PMID: 34535426 DOI: 10.1016/j.redare.2020.12.002] [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] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/14/2020] [Indexed: 06/13/2023]
Abstract
ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area. This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centres experience with the goal of improving comprehensive patient care.
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Affiliation(s)
- I Zarragoikoetxea
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Moreno
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Porta
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - T Koller
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Cegarra
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A I Gonzalez
- Servicio de Anestesiología y Reanimación, Hospital Puerta de Hierro, Madrid, Spain
| | - M Eiras
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Santiago, La Coruña, Spain
| | - E Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Aurelio Sarralde
- Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - B Quintana-Villamandos
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Vicente Guillén
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Ortiz G, Bastidas A, Garay-Fernández M, Lara A, Benavides M, Rocha E, Buitrago A, Díaz G, Ordóñez J, Reyes LF. Correlation and validity of imputed PaO2/FiO2 and SpO2/FiO2 in patients with invasive mechanical ventilation at 2600m above sea level. Med Intensiva 2021; 46:S0210-5691(21)00100-5. [PMID: 34167826 DOI: 10.1016/j.medin.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/06/2021] [Revised: 04/09/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To establish the correlation and validity between PaO2/FiO2 obtained on arterial gases versus noninvasive methods (linear, nonlinear, logarithmic imputation of PaO2/FiO2 and SpO2/FiO2) in patients under mechanical ventilation living at high altitude. DESIGN Ambispective descriptive multicenter cohort study. SETTING Two intensive care units (ICU) from Colombia at 2600m a.s.l. PATIENTS OR PARTICIPANTS Consecutive critically ill patients older than 18 years with at least 24h of mechanical ventilation were included from June 2016 to June 2019. INTERVENTIONS None. VARIABLES Variables analyzed were demographic, physiological messures, laboratory findings, oxygenation index and clinical condition. Nonlinear, linear and logarithmic imputation formulas were used to calculate PaO2 from SpO2, and at the same time the SpO2/FiO2 by severe hypoxemia diagnosis. The intraclass correlation coefficient, area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were calculated. RESULTS The correlation between PaO2/FiO2 obtained from arterial gases, PaO2/FiO2 derived from one of the proposed methods (linear, non-linear, and logarithmic formula), and SpO2/FiO2 measured by the intraclass correlation coefficient was high (greater than 0.77, p<0.001). The different imputation methods and SpO2/FiO2 have a similar diagnostic performance in patients with severe hypoxemia (PaO2/FiO2 <150). PaO2/FiO2 linear imputation AUC ROC 0,84 (IC 0.81-0.87, p<0.001), PaO2/FiO2 logarithmic imputation AUC ROC 0.84 (IC 0.80-0.87, p<0.001), PaO2/FiO2 non-linear imputation AUC ROC 0.82 (IC 0.79-0.85, p<0.001), SpO2/FiO2 oximetry AUC ROC 0.84 (IC 0.81-0.87, p<0.001). CONCLUSIONS At high altitude, the SaO2/FiO2 ratio and the imputed PaO2/FiO2 ratio have similar diagnostic performance in patients with severe hypoxemia ventilated by various pathological conditions.
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Affiliation(s)
- G Ortiz
- Pulmonary Medicine, Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Bastidas
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia.
| | - M Garay-Fernández
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Lara
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - M Benavides
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - E Rocha
- Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - A Buitrago
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - G Díaz
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - J Ordóñez
- Pulmonary Medicine Universidad El Bosque, Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia
| | - L F Reyes
- School of Medicine, Universidad de la Sabana, Clínica Universidad de La Sabana, Chía, Colombia
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Maskin LP, Wilken M, Rodriguez Lucci F, Wisnivesky JP, Barroso F, Wainsztein N. Risk factors for respiratory failure among hospitalized patients with Guillain-Barré syndrome. Neurologia 2021; 39:S0213-4853(21)00082-7. [PMID: 34074564 DOI: 10.1016/j.nrl.2021.04.011] [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: 01/26/2021] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy that can lead to respiratory failure. In this study, we evaluate early clinical risk factors for respiratory failure at the time of hospital admission. METHODS We studied a retrospective cohort of patients with GBS admitted to a tertiary care center. The potential risk factors studied were sociodemographic characteristics, GBS symptoms, overall and cervical muscle weakness (Medical Research Council [MRC] scores), electromyography findings, and cerebrospinal fluid analysis findings. Unadjusted odds ratios (OR) were calculated and exact logistic regression analysis (adjusted OR) performed to assess the association between baseline risk factors and respiratory failure. RESULTS Overall, 13 of 113 (12%) patients included in the study developed respiratory failure. Unadjusted analyses showed that involvement of any cranial nerve (OR: 14.7; 95% CI, 1.8-117.1), facial palsy (OR: 17.3; 95% CI, 2.2-138.0), and bulbar weakness (OR: 10.7; 95% CI, 2.3-50.0) were associated with increased risk of respiratory failure. Lower MRC sum scores (for scores <30, OR: 14.0; 95% CI, 1.54-127.2) and neck MRC scores (for scores ≤3, OR: 21.0; 95% CI, 3.5-125.2) were associated with higher likelihood of respiratory failure. Adjusted analyses showed that presence of bulbar weakness (OR: 7.6; 95% CI, 1.3-43.0) and low neck MRC scores (scores ≤3, OR: 9.2; 95% CI, 3.5-125.2, vs scores >3) were independently associated with respiratory failure. CONCLUSIONS Bulbar and neck muscle weakness at admission are clinical predictors of increased risk of respiratory failure in patients with GBS. These findings could guide the adequate management of high-risk patients.
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Affiliation(s)
- L P Maskin
- Intensive Care Unit, FLENI, Buenos Aires, Argentina.
| | - M Wilken
- Department of Neurology, FLENI, Buenos Aires, Argentina
| | | | - J P Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine Icahn School of Medicine at Mount Sinai, NY, USA
| | - F Barroso
- Department of Neurology, FLENI, Buenos Aires, Argentina
| | - N Wainsztein
- Intensive Care Unit, FLENI, Buenos Aires, Argentina
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Klausen MB, Gamst LH, Jensen HI. Implementation of extended possibility for CPAP in general wards: A quality inter-professional intervention project. J Healthc Qual Res 2021; 36:275-285. [PMID: 34045170 DOI: 10.1016/j.jhqr.2021.04.002] [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: 07/03/2020] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES In a Danish Hospital, 70% of all activations of the rapid response team (RRT) in 2016 were related to adult patients with respiratory insufficiency. The most frequent RRT intervention was continuous positive airway pressure (CPAP). However, there was no systematic follow-up and patients could not receive CPAP outside of daytime hours. The aim of the study was to implement and evaluate a CPAP intervention to improve healthcare. PATIENTS AND METHODS A quality inter-professional intervention project was conducted. The interventions consisted of: theoretical and practical education in respiratory insufficiency (including use of CPAP) of nurses and physicians from the general wards, physiotherapists and staff from the RRT; development of an instruction leaflet and video; an update of the existing guidelines. The interventions entailed patients being able to receive CPAP a minimum of 3 times for 5-10min within a 24-h period. All RRT activations were registered and compared in a before-after evaluation of the intervention. Additionally, all staff groups received an electronic questionnaire after implementation. RESULTS After implementation, respiratory insufficiency was still the highest primary course for RRT activation. The use of CPAP increased, and the number of patients needing a transfer to the intensive care unit decreased. The response rate for the questionnaire was 44% (203 out of 465), and staff experienced new competences, improved inter-professional cooperation and improved healthcare. However, a substantial number of staff did not feel sufficiently trained or that the intervention was well-implemented. CONCLUSION The intervention entailed new competences for the staff, as well as improved system performance, inter-professional cooperation and healthcare. However, there is a need for continuous focus on the intervention.
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Affiliation(s)
- M B Klausen
- Department of Anaesthesiology and Intensive Care, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
| | - L H Gamst
- Department of Anaesthesiology and Intensive Care, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - H I Jensen
- Department of Anaesthesiology and Intensive Care, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Gochi Valdovinos A, Arriaga-Redondo M, Dejuan Bitriá E, Pérez Rodríguez I, Márquez Isidro E, Blanco Bravo D. [Prenatal therapy with magnesium sulphate and intestinal obstruction due to meconium in preterm newborns]. An Pediatr (Barc) 2020; 96:S1695-4033(20)30483-5. [PMID: 33358528 DOI: 10.1016/j.anpedi.2020.10.022] [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: 07/09/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Magnesium sulphate (MgSO4) therapy has shown to be useful as a neurological protector in the preterm newborn below 32 weeks of gestation. The most documented adverse effect is cardiorespiratory failure, whereas its relationship with meconium obstruction is controversial. The main objective of this study was to analyse the possible association between prenatal MgSO4 therapy and meconium obstruction. PATIENTS AND METHODS An analytical retrospective study was conducted on < 32 weeks preterm babies admitted to a tertiary-level hospital (January 2016-December 2017). Epidemiological, prenatal and postnatal data on the outcomes were obtained, analysed and compared in both groups (exposed to MgSO4 and not exposed). RESULTS The study included 201 patients (146 exposed and 55 non-exposed). There were no significant differences in the mean gestational age (28.4 ± 2.2 vs. 28.7 ± 2.8 weeks, respectively), or in the rest of epidemiological and perinatal variables. Prenatal corticosteroid therapy was more frequent in the MgSO4 group (75.9 vs. 53.7%; p = .002), and in the non-exposed group there were more multiple pregnancies (52.7 vs. 36.6%; p = .027), and female gender (56.4 vs. 37%; p = .013). There were no statistically significant differences in the presence of meconium obstruction (75.9% in exposed vs. 67.3% in non-exposed; p = .23), although repeated rectal stimulation was more frequent in the exposed group (43.2 vs. 27.9%; p = .08). Furthermore, there were no significant differences in the main cardiorespiratory variables: 1-minute Apgar score (6.2 in MgSO4- exposed vs. 5.6 in non-exposed; p = .75), 5-minutes Apgar score (7.9 vs. 7.6; p = .31), advanced newborn resuscitation (26 vs. 31.5%; p = .44), maximum FiO2 (45.5 vs. 48; p = .58), and initial inotropic requirements (10.3 vs. 20.8%; p = .55). CONCLUSIONS This study found no correlations between MgSO4 therapy and meconium obstruction or cardiorespiratory failure.
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Affiliation(s)
| | | | - Ester Dejuan Bitriá
- Hospital Materno Infantil, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - Elena Márquez Isidro
- Hospital Materno Infantil, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Dorotea Blanco Bravo
- Hospital Materno Infantil, Hospital Universitario Gregorio Marañón, Madrid, España
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Mateos-Rodríguez A, Ortega-Anselmi J, Candel-González FJ, Canora-Lebrato J, Fragiel-Saavedra M, Hernández-Píriz A, Behzadi-Koocahni N, González-Del Castillo J, Pérez-Alonso A, de la Cruz-Conty ML, García-de Casasola G, Marco-Martínez J, Zapatero-Gaviria A. [Alternative CPAP methods for the treatment of secondary serious respiratory failure due to pneumonia by COVID-19]. Med Clin (Barc) 2020; 156:55-60. [PMID: 33239247 PMCID: PMC7833909 DOI: 10.1016/j.medcli.2020.09.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/04/2022]
Abstract
Introducción El uso de dispositivos que aportan presión positiva continua en la vía aérea ha demostrado mejoría en diversas patologías que producen insuficiencia respiratoria. En el episodio de pandemia por COVID-19, el uso de estos dispositivos se ha generalizado, pero, debido a la escasez de dispositivos convencionales de presión positiva continua en la vía aérea (CPAP), se han fabricado dispositivos alternativos. El objetivo de este estudio es describir el uso de estos, así como su eficacia. Material y métodos Se recogen datos de pacientes ingresados por neumonía por COVID-19 en el Hospital de Campaña de IFEMA, así como datos de pacientes con insuficiencia respiratoria y necesidad de soporte ventilatorio. Resultados Estudio realizado sobre un total de 23 pacientes, con fecha de ingreso de entre el 24 de marzo y el 28 de abril en IFEMA. Se empleó CPAP alternativa en cinco pacientes (21,7%), mientras que, en los 18 restantes (78,3%) se usó un soporte ventilatorio con mascarilla reservorio o Ventimask efecto Venturi. Se observó un aumento progresivo de la saturación en aquellos pacientes en los que se empleó CPAP alternativa (de 94% de promedio a 98 y 99% de promedio, tras 30 y 60 minutos con la máscara, respectivamente), aunque este cambio no resultó significativo (p = 0,058 y p = 0,122, respectivamente). De igual manera, no se observó un cambio significativo de frecuencia respiratoria al inicio y al final de la medición en pacientes que usaron CPAP alternativa (p = 0,423) pero sí entre los que no la usaron (p = 0,001). Se observó una mejoría estadísticamente significativa en la variable de saturación de oxígeno/fracción inspirado de oxígeno en los pacientes que usaron CPAP alternativa (p = 0,040). Conclusión El uso de estos dispositivos ha ayudado al trabajo ventilatorio de varios pacientes, mejorando sus parámetros de oxigenación. Para observar mejor la evolución de los pacientes sometidos a esta terapia y compararlos con pacientes con otro tipo de soporte ventilatorio, son necesarios más estudios en los que se aleatorice su uso.
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Affiliation(s)
- Alonso Mateos-Rodríguez
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Servicio de Urgencias Médicas de Madrid SUMMA112, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, España.
| | - Justo Ortega-Anselmi
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario Clínico San Carlos, Madrid, España
| | | | - Jesús Canora-Lebrato
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario de Fuenlabrada, Madrid, España
| | - Marcos Fragiel-Saavedra
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario Clínico San Carlos, Madrid, España
| | - Alba Hernández-Píriz
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario de Fuenlabrada, Madrid, España
| | - Navid Behzadi-Koocahni
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Servicio de Urgencias Médicas de Madrid SUMMA112, Madrid, España
| | - Juan González-Del Castillo
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario Clínico San Carlos, Madrid, España
| | - Antonio Pérez-Alonso
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Servicio de Asistencia Municipal de Urgencias y Rescates-Protección Civil, Madrid, España
| | | | - Gonzalo García-de Casasola
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario Infanta Cristina, Madrid, España
| | - Javier Marco-Martínez
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario Clínico San Carlos, Madrid, España
| | - Antonio Zapatero-Gaviria
- Hospital de Campaña IFEMA COVID-19, Madrid, España; Hospital Universitario de Fuenlabrada, Madrid, España
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Rodríguez A, Moreno G, Gómez J, Carbonell R, Picó-Plana E, Benavent Bofill C, Sánchez Parrilla R, Trefler S, Esteve Pitarch E, Canadell L, Teixido X, Claverias L, Bodí M; por el HJ23-COVID-19 working group., Listado de Investigadores del HJ23-COVID-19 Working Group. Laboratorio clínico., Epidemiología y prevención de la infección nosocomial., Departamento de enfermería UCI., Farmacia clínica., Médicos UCI., UCI Data-Analitics. Severe infection due to the SARS-CoV-2 coronavirus: Experience of a tertiary hospital with COVID-19 patients during the 2020 pandemic. Med Intensiva 2020; 44:525-33. [PMID: 32654921 DOI: 10.1016/j.medin.2020.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/18/2020] [Accepted: 05/23/2020] [Indexed: 02/06/2023]
Abstract
Objetivo Describir las características clínicas y respiratorias de una cohorte de 43 pacientes con COVID-19 tras 28 días de evolución. Diseño Prospectivo, observacional en un solo centro. Ámbito Medicina intensiva. Pacientes Pacientes ingresados por COVID-19 e insuficiencia respiratoria. Intervenciones Ninguna. Variables Se obtuvieron de forma automática variables demográficas, de gravedad, de laboratorio, de asistencia ventilatoria recibida (oxigenoterapia alto flujo [OAF] y ventilación mecánica invasiva [VMI]), de oxigenación (PaO2, PaO2/FiO2) y de complicaciones. Los pacientes se dividieron en 3 grupos: supervivientes (G1), fallecidos (G2) y aquellos que continuaban ingresados (G3). Se utilizó la prueba de Chi-cuadrado o de Fisher (variables categóricas) y la U de Mann-Whitney o Wilcoxon para analizar la diferencia entre medianas. Se consideró significativo un valor de p < 0,05. Resultados Se incluyeron 43 pacientes (G1 = 28 [65,1%]; G2 = 10 [23,3%] y G3 = 5 [11,6%]), edad 65 (52-72) años, 62% varones, APACHE II 18 (15-24), SOFA 6 (4-7), hipertensión arterial (30,2%) y obesidad (25,6%) fueron las comorbilidades más frecuentes. La OAF fue usada en el 62,7% de pacientes, el 85% fracasó. El 95% de los pacientes necesitó VMI y el 85% ventilación en prono. En la población general, la PaO2/FiO2 inicial mejoró a los 7 días (165 [125-210] vs. 194 [153-285]; p = 0,02), al igual que en el G1 (164 [125-197] vs. 207 [160-294]; p = 0,07), pero no en el G2 (163 [95-197] vs. 135 [85-177]). No se observó co-infección bacteriana. El desarrollo de neumonía asociada a la VMI fue elevado (13 episodios/1.000 días de VMI). Conclusiones Los pacientes con COVID-19 requieren VMI precoz, elevada frecuencia de ventilación en prono y presentan alta prevalencia de fracaso a la OAF. La falta de mejoría de la PaO2/FiO2 a los 7 días podría ser un marcador de pronóstico.
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Manso Ruiz de la Cuesta R, Del Villar Guerra P, Medina Villanueva A, Modesto Alaport V, Molinos Norniella C, Bartolomé Albistegui MJ, García González V. [CPAP vs oxygen therapy in infants being transported due to acute respiratory failure]. An Pediatr (Barc) 2020; 93:152-160. [PMID: 32044198 DOI: 10.1016/j.anpedi.2019.07.011] [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: 05/20/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy. MATERIALS AND METHODS We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU. RESULTS We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = -1.08; 95% CI = -1.76 to -0.40; P = .002) and the heart rate (beta = -19.64, 95% CI = -28.46 to -10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04. CONCLUSIONS Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy.
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Affiliation(s)
| | | | | | - Vicent Modesto Alaport
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitari i Politècnic La Fe de València, Valencia, España
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Vásquez-Hoyos P, Jiménez-Chaves A, Tovar-Velásquez M, Albor-Ortega R, Palencia M, Redondo-Pastrana D, Díaz P, Roa-Giraldo JD. [Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude]. Med Intensiva 2019; 45:195-204. [PMID: 31826812 DOI: 10.1016/j.medin.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/02/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. OBJECTIVE To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure. METHODOLOGY A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24hours. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest. RESULTS A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24hours. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48-5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21-2.01). CONCLUSIONS HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure.
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Affiliation(s)
- P Vásquez-Hoyos
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Universidad Nacional de Colombia, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia.
| | | | - M Tovar-Velásquez
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
| | - R Albor-Ortega
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - M Palencia
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
| | - D Redondo-Pastrana
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
| | - P Díaz
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - J D Roa-Giraldo
- Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Hospital de San José de Bogotá, Bogotá, Colombia
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19
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Rodriguez-Ruiz E, Barral-Segade P, Fernández-González ÁL, Prim JMG, Galbán Rodríguez C. Venovenous extracorporeal membrane oxygenation as a bridge to traumatic bronchial fistula closure. ACTA ACUST UNITED AC 2019; 66:533-6. [PMID: 31601431 DOI: 10.1016/j.redar.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 11/20/2022]
Abstract
Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient.
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20
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Charco-Roca LM, Martín-Fuentes A, Gambarrutta-Malfatti C, Cuesta-Montero P. [Diaphragmatic pacemaker dysfunction and utility of diaphragmatic ultrasonography]. Rehabilitacion (Madr) 2019; 53:116-20. [PMID: 31186093 DOI: 10.1016/j.rh.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 11/23/2022]
Abstract
Patients with spinal cord injuries above the C5 vertebrae have a high risk of respiratory complications, and complete spinal cord injures can require support with mechanical ventilation. In selected patients, implantation of a diaphragmatic pacemaker offers the possibility of breathing without mechanical support and reduces respiratory complications, increasing the patient's independence. Ultrasonography is a simple and non-invasive technique that may be useful in the differential diagnosis of thoracic diseases. We present the case of a patient with a traumatic cervical spinal cord injury, who underwent diaphragmatic pacemaker implantation. The use of ultrasound allowed rapid and reliable diagnosis of device malfunction. M-mode diaphragmatic ultrasonography is a simple and non-invasive technique that can be incorporated into routine clinical practice to diagnose diaphragm movement disorders.
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21
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Piñero-Zapata M, Torres-Corbalán L. The use of home non-invasive ventilation and the reduction of inhospital mortality of patients with respiratory failure. Enferm Clin (Engl Ed) 2018; 28:351-358. [PMID: 30025797 DOI: 10.1016/j.enfcli.2018.06.005] [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: 12/13/2017] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish the relationship between the use of home non-invasive ventilation (NIV) and inhospital mortality in people admitted due to exacerbation of their respiratory disease. METHODS Retrospective cohort study with 191 cases of patients attended at the emergency department of the Reina Sofía General University Hospital in Murcia due to ARF of any cause and who required NIV as supportive treatment. RESULTS Mortality among patients using NIV as routine home treatment was 6.45%, compared to 20.1% among those who did not use it (P<.05). CONCLUSIONS routine domiciliary treatment with NIV has been shown to be a protective factor against inpatient hospital mortality for patients who underwent NIV during their admission, through the emergency department, for acute respiratory failure or acute chronic disease, regardless of the triggering pathology.
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22
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Carmona-Bayonas A, Gordo F, Beato C, Castaño Pérez J, Jiménez-Fonseca P, Virizuela Echaburu J, Garnacho-Montero J. Intensive care in cancer patients in the age of immunotherapy and molecular therapies: Commitment of the SEOM-SEMICYUC. Med Intensiva 2018. [PMID: 29519710 DOI: 10.1016/j.medin.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cancer patients are a vulnerable group exposed to numerous and serious risks beyond cancer itself. In recent years, the prognosis of these individuals has improved substantially thanks to several advances such as immunotherapy, targeted molecular therapies, surgical techniques, or developments in support treatment. This coincides with the prolonged survival of oncological patients admitted to the ICU due to critical complications, and under the supervision of intensivists. The time has therefore come to revisit the intensive care support of these patients, which poses new professional as well as organizational challenges. An agreement was signed in 2017 between the SEOM and SEMICYUC with the aim of improving the quality of care of cancer patients with critical complications. The initiative seeks to aid in decision-making, standardize criteria, decrease subjectivity, generate channels of communication, and delve deeper into the ethical and scientific aspects of these situations. This document sets forth the most important reasons that have led us to undertake this initiative.
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Affiliation(s)
- A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), UMU, Murcia, Spain
| | - F Gordo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares (Coslada-Madrid), Grupo de investigación en patología crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - C Beato
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - J Castaño Pérez
- Intensive Care Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Virizuela Echaburu
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - J Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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23
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Morales Quinteros L, Bringué Roque J, Kaufman D, Artigas Raventós A. Importance of carbon dioxide in the critical patient: Implications at the cellular and clinical levels. Med Intensiva 2018; 43:234-242. [PMID: 29486904 DOI: 10.1016/j.medin.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/20/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 01/22/2023]
Abstract
Important recent insights have emerged regarding the cellular and molecular role of carbon dioxide (CO2) and the effects of hypercapnia. The latter may have beneficial effects in patients with acute lung injury, affording reductions in pulmonary inflammation, lessened oxidative alveolar damage, and the regulation of innate immunity and host defenses by inhibiting the expression of inflammatory cytokines. However, other studies suggest that CO2 can have deleterious effects upon the lung, reducing alveolar wound repair in lung injury, decreasing the rate of reabsorption of alveolar fluid, and inhibiting alveolar cell proliferation. Clearly, hypercapnia has both beneficial and harmful consequences, and it is important to determine the net effect under specific conditions. The purpose of this review is to describe the immunological and physiological effects of carbon dioxide, considering their potential consequences in patients with acute respiratory failure.
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Affiliation(s)
| | | | - David Kaufman
- Division of Pulmonary, Critical Care & Sleep, NYU School of Medicine, New York, NY, Estados Unidos
| | - Antonio Artigas Raventós
- Servicio de Medicina Intensiva, Hospital Universitario Sagrat Cor, Barcelona, España; Universidad Autónoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, España
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24
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Ferrà C, Xicoy B, Castillo N, Morgades M, Juncà J, Andreo F, Millá F, Feliu E, Ribera JM. Usefulness of bronchoalveolar lavage and flow cytometry in patients with hematological malignancies and respiratory failure. Med Clin (Barc) 2017; 148:297-302. [PMID: 28143650 DOI: 10.1016/j.medcli.2016.10.045] [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: 07/27/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Strategies to improve the efficiency of bronchoalveolar lavage (BAL) are needed. We conducted a study to establish the diagnostic value of BAL in patients with hematological malignancies and pulmonary infiltrates. PATIENTS AND METHODS The correlation of cytologic and flow cytometric study of BAL with the microbiological findings and the clinical evolution was determined. RESULTS Seventy BAL were performed and flow cytometric study was analyzed in 23 of them. Fifty-three patients did not present any adverse event attributable to BAL. Anti-infectious therapy was modified in 64 (91%) patients. T lymphocyte count >0.3×109/l in peripheral blood was associated with longer OS at 3 years (53 vs. 22%, p=.009). Higher CD4 (>20/μL) and CD8 (>35/μL) lymphocyte counts in the BAL were associated with a longer OS at 3 years: 82 vs. 21% (p=.030) and 80 vs. 23% (p=.059). CONCLUSIONS Our study confirms the clinical value of BAL for treatment decision making in patients with hematological malignancies and acute respiratory failure.
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Affiliation(s)
- Christelle Ferrà
- Servicio de Hematología, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, España; Instituto de Investigación contra la Leucemia Josep Carreras, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Blanca Xicoy
- Servicio de Hematología, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, España; Instituto de Investigación contra la Leucemia Josep Carreras, Badalona, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Nerea Castillo
- Servicio de Hematología, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, España
| | - Mireia Morgades
- Servicio de Hematología, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, España
| | - Jordi Juncà
- Instituto de Investigación contra la Leucemia Josep Carreras, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Felipe Andreo
- Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, España
| | - Fuensanta Millá
- Servicio de Hematología, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, España; Instituto de Investigación contra la Leucemia Josep Carreras, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Evarist Feliu
- Servicio de Hematología, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, España; Instituto de Investigación contra la Leucemia Josep Carreras, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
| | - Josep-María Ribera
- Servicio de Hematología, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, España; Instituto de Investigación contra la Leucemia Josep Carreras, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
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Jacob J, Arranz M, Sancho Ramoneda M, Lopez À, Navarro Sáez MC, Cousiño Chao JR, López Altimiras X, López I Vengut F, García Trallero O, Zorrilla J, German A, Farré Cerdà J, Lista E. [Noninvasive mechanical ventilation in emergency services in Catalonia: the VNICat registry cohort study]. Emergencias 2017; 29:33-38. [PMID: 28825266] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To study how noninvasive ventilation (NIV) is used in prehospital emergency services and hospital emergency departments. To explore associations between NIV use and hospital mortality. MATERIAL AND METHODS Prospective analysis of a consecutive multicenter cohort of patients who were treated with NIV between February and March 2015. The study was undertaken in emergency medical services in Catalonia and 8 Catalan hospital emergency departments. We collected information during the acute episode and on discharge, as well as data describing the patients' condition when stable. The dependent variable was all-cause hospital mortality. RESULTS We studied 184 acute episodes requiring NIV, in the prehospital setting in 25 cases (13.6%) and in the hospital in 159 (86.4%). The most common scenario was acute heart failure (AHF) (38.0%). The second most common was chronic obstructive pulmonary disease (COPD) (34.2%). In most cases, NIV was discontinued in the emergency department. Mortality was 7.5% during prehospital care and 21.4% in the hospital. Hospital mortality was associated with limiting the use of life support. We detected no significant differences in mortality between the groups of patients with AHF vs COPD. CONCLUSION The use of NIV in prehospital and hospital emergency care follows current evidence-based recommendations and is required more often for AHF than for exacerbated COPD. Hospital mortality is high in this context and is associated with frequent limiting of life support.
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Affiliation(s)
- Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - María Arranz
- Servicio de Urgencias, Hospital de Viladecans, Barcelona, España
| | | | | | | | | | | | - Francesc López I Vengut
- Servicio de Urgencias, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
| | | | - José Zorrilla
- Servicio de Urgencias, Xarxa Assistencial de Manresa, Fundació Althaia, Barcelona, España
| | - Antonio German
- Servicio de Urgencias, Hospital Universitari Mútua de Terrassa, Barcelona, España
| | - Jaume Farré Cerdà
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, España
| | - Eva Lista
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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26
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Raurell-Torredà M, Romero-Collado A, Rodríguez-Palma M, Farrés-Tarafa M, Martí JD, Hurtado-Pardos B, Peñarrubia-San Florencio L, Saez-Paredes P, Esquinas AM. Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts. Enferm Intensiva 2017; 28:31-41. [PMID: 28153465 DOI: 10.1016/j.enfi.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. OBJECTIVES To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. METHODOLOGY Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel. RESULTS Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet® hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. CONCLUSIONS The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Vicepresidenta SEEIUC, Coordinadora del documento, Barcelona, España.
| | | | - M Rodríguez-Palma
- Residencia de Mayores José Matía Calvo, Miembro Comité Director GNEAUPP, Cádiz, España
| | - M Farrés-Tarafa
- Campus Docent Sant Joan de Déu, Presidenta del Comité Científico de Enfermería de la SECIP, Barcelona, España
| | - J D Martí
- Hospital Clínic de Barcelona, Miembro del Comité Científico SEPAR, Barcelona, España
| | - B Hurtado-Pardos
- Campus Docent Sant Joan de Déu, Miembro del Comité Científico de la SECIP, Barcelona, España
| | - L Peñarrubia-San Florencio
- Hospital Materno-infantil Sant Joan de Déu, Miembro del Comité Científico de la SECIP, Barcelona, España
| | - P Saez-Paredes
- Hospital General Universitario José María Morales Messeguer, Murcia, España
| | - A M Esquinas
- Hospital General Universitario José María Morales Messeguer, Presidente Asociación Internacional de Ventilación No Invasiva, Murcia, España
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Lopez Saubidet I, Maskin LP, Rodríguez PO, Bonelli I, Setten M, Valentini R. Mortality in patients with respiratory distress syndrome. Med Intensiva 2015; 40:356-63. [PMID: 26746127 DOI: 10.1016/j.medin.2015.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 08/13/2015] [Revised: 10/15/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Mortality in Acute Respiratory Distress Syndrome (ARDS) is decreasing, although its prognosis after hospital discharge and the prognostic accuracy of Berlin's new ARDS stratification are uncertain. METHODS We did a restrospective analysis of hospital and 6 month mortality of patients with ARDS admitted to the Intensive Care Unit of a Univeristy Hospital in Buenos Aires, between January 2008 and June 2011. ARDS was defined by PaO2/FiO2 lower than 200 mmHg under ventilation with at least 10 cm H2O of PEEP and a FiO2 higher or equal than 0.5. and the presence of bilateral infiltrates in chest radiography, in the absence of cardiogenic acute pulmonary edema, during the first 72 hs of mechanical ventilation. Mortality associated risk factors, the use of rescue therapies and Berlin's stratification for moderate and severe ARDS patients were considered. RESULTS Ninety eight patients were included; mean age was 59±19 years old, 42,9% had mayor co-morbidities; APACHE II at admission was 22±7; SOFA at day 1 was 8±3. Prone position ventilation was applied in 20,4% and rescue measures in 12,2% (12 patients with nitric oxide and 1 with extracorporeal membrane oxygenation). Hospital and 6 months mortality were 37.7 and 43.8% respectively. After logistic regression analysis, only age, the presence of septic shock at admission, Ppl >30 cmH2O, and major co-morbidities were independently associated with hospital outcome. There was no difference between moderate and severe groups (41,2 and 36,8% respectively; p=0,25). CONCLUSION In this cohort, including patients with severe hypoxemia and high percentage of mayor co-morbidities, ARDS associated mortality was lower than some previous studies. There was no increase in mortality after hospital discharge. There was no difference in mortality between moderate and severe groups according to Berlin's definition.
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Affiliation(s)
- I Lopez Saubidet
- Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC , Buenos Aires, Argentina.
| | - L P Maskin
- Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC , Buenos Aires, Argentina
| | - P O Rodríguez
- Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC , Buenos Aires, Argentina
| | - I Bonelli
- Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC , Buenos Aires, Argentina
| | - M Setten
- Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC , Buenos Aires, Argentina
| | - R Valentini
- Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC , Buenos Aires, Argentina
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Raurell-Torredà M, Argilaga-Molero E, Colomer-Plana M, Ruiz-García T, Galvany-Ferrer A, González-Pujol A. [Intensive care unit profesionals's knowledge about non invasive ventilation comparative analysis]. Enferm Intensiva 2015; 26:46-53. [PMID: 25841590 DOI: 10.1016/j.enfi.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/01/2014] [Revised: 12/11/2014] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Abstract
AIMS The literature highlights the lack of noninvasive ventilation (NIV) protocols and the variability of the knowledge of NIV between intensive care units (ICU) and hospitals, so we want to compare NIV nurses's Knowledge from 4 multipurpose ICU and one surgical ICU. METHODS Multicenter, crosscutting, descriptive study in three university hospitals. The survey instrument was validated in a pilot test, and the calculated Kappa index was 0.9. Returning a completed survey is an indication of informed consent. Analysis by Chi square test. RESULTS 117 responded (65%) nurses, 11±9.7 years of experience in ICU and 9.2±7.2 in use of NIV. One of the multipurpose ICU, was initiated NIV an average of 6 years later than the others (95% CI [3.3 to 8.6], P<.001). Only 23.1% of nurses would place a non-vented mask (with no exhalation port) by conventional ventilator, the rest any kind of face mask. 12.7% believed that the mask must be adjusted to the "2-finger" fit while 29% would seal the mask to the patient's face and cover the mask opening where air escapes to facilitate patient/ventilator synchronization. In the surgical ICU agitation identifies mostly as a complication of NIV compared with multipurpose UCIs (31.6% vs 1.8%, P<.001). 56.4% of nurses do not consider respiratory physiotherapy as nursing care, with no difference between units. CONCLUSIONS Knowledge about types of interface is very dependent on the material of the unit. More training for complications of NIV as agitation and handling secretions it is necessary.
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Affiliation(s)
| | - E Argilaga-Molero
- UCI, Hospital Universitario de Bellvitge, GRIN-IDIBELL, L'Hospitalet de Llobregat, Barcelona , España
| | - M Colomer-Plana
- UCI, Hospital Universitario de Girona Dr.Josep Trueta, Girona , España
| | - T Ruiz-García
- UCI, Hospital Universitario Clínic, Barcelona, España
| | - A Galvany-Ferrer
- UCI, Hospital Universitario de Girona Dr.Josep Trueta, Girona , España
| | - A González-Pujol
- UCI, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona , España
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29
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Velasco Sanz TR, Sánchez de la Ventana AB. [High-flow nasal cannula oxygen therapy in critical patients. Prospective study]. Enferm Intensiva 2014; 25:131-6. [PMID: 25441723 DOI: 10.1016/j.enfi.2014.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/15/2013] [Revised: 05/19/2014] [Accepted: 06/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze the incidence of use of high-flow nasal cannula oxygen (HFNC) in intensive care and evaluate the procedure. BASIC PROCEDURES descriptive prospective study. INCLUSION CRITERIA all participants were patients admitted to the intensive care units of the hospital Clínico San Carlos November 2012 - January 2013 that required HFNC. VARIABLES socio-demographic; indications, complications, objectives and flows of the therapy. Statistical analysis with average, standard deviation and percentages, with the statistical program SPSS ver18.0. RESULTS 12 cases of which 58.3% were men, with a mean age 68.66 (± 12) and with NEMS 33.25 (±7). The incidence of HFNC was 0.95%. The indication of HFNC was: 75% moderate respiratory failure or need for oxygen supply greater than 40%, 58.3% hypoxemia without hypercapnia, the 41.7% withdrawal and/or employment with non-invasive mechanical ventilation, the 25% support post-extubation, the 16.7% exacerbations of heart failure, the 16.7% improve respiratory work and the 8.3% acute lung edema. The main complications of the HFNC were: mouth-breathing (8.3%), nasal injury (8.3%) and abundant secretions (8.3%). In the fulfilment of the objectives of the HFNC, there was a 91.7% improvement of oxygen therapy, and in 50% of the cases orotracheal intubation was averted. CONCLUSIONS There is a low incidence of HFNC in the unit. The main indication is the moderate respiratory failure or the high need for oxygen supply. Almost all patients have improved with oxygen therapy, although it has not been possible to avoid intubation.
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Affiliation(s)
- T R Velasco Sanz
- Departamento de Medicina Intensiva, Hospital Clínico San Carlos, , Madrid, España.
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30
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Sanjuán-López P, Valiño-López P, Ricoy-Gabaldón J, Verea-Hernando H. Amyotrophic lateral sclerosis: impact of pulmonary follow-up and mechanical ventilation on survival. A study of 114 cases. Arch Bronconeumol 2014; 50:509-13. [PMID: 24931271 DOI: 10.1016/j.arbres.2014.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/15/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the impact of ventilatory management and treatment on the survival of patients with amyotrophic lateral sclerosis (ALS). METHOD Retrospective analysis of 114 consecutive patients admitted to a general hospital, evaluating demographic data, type of presentation, clinical management, treatment with mechanical ventilation and survival. STATISTICS descriptive and Kaplan-Meier estimator. RESULTS Sixty four patients presented initial bulbar involvement. Overall mean survival after diagnosis was 28.0 months (95%CI, 21.1-34.8). Seventy patients were referred to the pulmonary specialist (61.4%) and 43 received non-invasive ventilation (NIV) at 12.7 months (median) after diagnosis. Thirty seven patients continued to receive NIV with no subsequent invasive ventilation. The mean survival of these patients was 23.3 months (95%CI, 16.7-28.8), higher in those without bulbar involvement, although below the range of significance. Survival in the 26 patients receiving programmed NIV was higher than in the 11 patients in whom this was indicated without prior pulmonary assessment (considered following diagnosis, P<.012, and in accordance with the start of ventilation, P<.004). A total of 7 patients were treated invasively; mean survival in this group was 72 months (95%CI, 14.36-129.6), median 49.6±17.5 (95%CI, 15.3-83.8), and despite the difficulties involved in home care, acceptance and tolerance was acceptable. CONCLUSIONS Long-term mechanical ventilation prolongs survival in ALS. Programmed pulmonary assessment has a positive impact on survival of ALS patients and is key to the multidisciplinary management of this disease.
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Affiliation(s)
- Pilar Sanjuán-López
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España
| | - Paz Valiño-López
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España
| | - Jorge Ricoy-Gabaldón
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España
| | - Héctor Verea-Hernando
- Servicio de Neumología, Complexo Hospitalario Universitario A Coruña, CHUAC, A Coruña, España.
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Mocanu SN, Balagué Ponz MC, Targarona Soler EM, Roque Figuls M, Trias Folch M. [Influence of the type of thoracic access on postesophagectomy respiratory complications]. Cir Esp 2013; 91:563-73. [PMID: 24050831 DOI: 10.1016/j.ciresp.2013.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 03/15/2013] [Accepted: 03/22/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A systematic review of the literature was performed with the aim to determine differences in the rate of respiratory complications after esophagectomy for esophageal cancer using minimally invasive access vs traditional thoracic access. METHODS A literature search was performed using Medline and Cochrane Library, identifying studies that compared the 2 types of thoracic access, regardless of the type of abdominal access (laparotomy/laparoscopy). The studies selected described respiratory complications in absolute numbers and different categories. Studies that considered minithoracotomy as a minimally invasive technique were excluded. Inclusion criteria were: studies decribing the different types of respiratory complications (9 in total), and analysing the most common complications: respiratory infection, respiratory failure and pleural effusion. RESULTS Nine studies were selected (one prospective randomized trial and 8 case control studies) including 1,190 patients, 1,167 of which were operated on for esophageal cancer: 482 patients by thoracotomy and 708 by thoracoscopy. Three studies included definitions of respiratory complications, and one stratified them. The more frequent complications that allowed a meta-analysis were: respiratory infections, pleural effusion, and respiratory failure. No significant differences were found between the 2 types of access in the global analysis. DISCUSSION The type of thoracic access (thoracotomy or thoracoscopy) does not seem to influence the development of respiratory complications after esophagectomy for cancer. However, the design of the studies analysed, the absence of clear definitions and stratification of the complications makes this conclusion questionable. A consensus on the definition of complications and further prospective randomized clinical trials are necessary.
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