Descripción y análisis de mortalidad a corto y medio plazo en una unidad de cuidados respiratorios intermedios: nuestra experiencia / Pdescription and analysis of short and medium-term mortality in an intermediate respiratory care unit: our experience

Objetivo: Describir y analizar la mortalidad de los pacientes que ingresan en nuestra UCRI, tanto durante el ingreso en dicha UCRI, como a lo largo de toda la estancia hospitalaria, y a los 3 y 6 meses del alta hospitalaria. Metodología: Estudio prospectivo de 380 pacientes, no Covid, ingresados en nuestra UCRI, destinada al tratamiento del fallo respiratorio agudo con VMNI, a lo largo de año y medio de actividad. Se recogieron datos demográficos, índice de Charlson modificado (m), tipo de fallo respiratorio, servicio de pertenencia, días de estancia en UCRI y la mortalidad tanto en UCRI como hospitalaria, y a los 3 y 6 meses del alta del hospital. Resultados: El 55% eran varones con una edad media de 71 años y un índice de Charlson (m) de 6,4. La mortalidad en UCRI fue del 16.4% y la intrahospitalaria del 27%, relacionándose ambas con la edad, el índice de Chalson (m), el servicio de pertenencia y el fallo respiratorio hipoxémico. Tras el alta hospitalaria, la supervivencia a los tres meses fue del 83,6% y a los 6 meses del 75,5% relacionándose ambas con la edad y el índice de Charlson (m). Conclusiones: Las UCRIs son útiles en el tratamiento del fallo respiratorio agudo en pacientes con alta carga de comorbilidad, permitiendo a tales pacientes tener una elevada supervivencia a medio plazo tras el alta hospitalaria. (AU)

Objective: describe and analyze the mortality of patients admitted to our IRCU, both during admission to said IRCU, and throughout the entire hospital stay, and 3 and 6 months after hospital discharge. Methodology: prospective study of 380 non-Covid patients admitted to our IRCU, intended for the treatment of acute respiratory failure with NIV, over a year and a half of activity. Demographic data, modified Charlson index (m), type of respiratory failure, service affiliation, days of stay in the IRCU, and mortality both in the IRCU and in hospital, and at 3 and 6 months after hospital discharge were collected. Results: 55% were men with a mean age of 71 years and a Charlson index (m) of 6.4. Mortality in the IRCU was 16.4% and in-hospital mortality was 27%, both being related to age, the Chalson index (m), the service to which they belong, and hypoxemic respiratory failure. After hospital discharge, survival at three months was 83.6% and at 6 months was 75.5%, both related to age and the Charlson index (m). Conclusions: IRCU are useful in the treatment of acute respiratory failure in patients with a high burden of comorbidity, allowing such patients to have a high medium-term survival after hospital discharge. (AU)

Uso de la determinación transcutánea de co2 en pacientes con déficit de timidina quinasa 2 y costes de su uso en una consulta de ventilación mecánica no invasiva / Use of transcutaneous co2 determination in patients with thymidine kinase 2 deficit and costs of its use in a noninvasive mechanical ventilation consultation

Objetivo: Describir el uso de la capnografía transcutánea en una población adulta y pediátrica de pacientes con déficit de timidina quinasa 2 y hacer un estudio comparativo de costes de una determinación de gasometría arterial y capnografía en la población de nuestra consulta de VMNI. Metodología: Se realizó una anamnesis y unas pruebas funcionales respiratorias para valorar afectación de la musculatura respiratoria y calidad del sueño. Para determinar la hipoventilación, se midió la pCO2 transcutánea en vigilia y/o durante el sueño. Se realizó un estudio económico para comparar el coste de una determinación de ptcCO2 frente a la determinación mediante GSA. El estudio económico se realizó estimando la población total de pacientes que se valoraba en la consulta de VMNI de manera anual. Resultados: 9 pacientes con déficit de TK2 (4 adultos y 5 niños). A 4 pacientes se les realizó una poligrafía respiratoria basal. A la población pediátrica se les realizó un registro continuo de ptcCO2 con pulsioximetria anual. Se realizaron 4 registros con ptcCO2 y VMNI. Elcoste de la determinación de ptCO2 en comparación con la GSA fue de 6,29 euros frente a 5,37 euros. Conclusiones: La medición de la ptcCO2 es útil en la consulta de VMNI para la realización de medidas puntuales en la consulta como para monitorización continua durante el sueño. Con el uso que realizamos en nuestra consulta de la capnografía transcutánea, la determinación puntual de la pCO2 transcutánea es más económica que la realización de la GSA. (AU)

Objective: to describe the use of transcutaneous capnography in an adult and pediatric population of patients with Thymidine inase 2 deficiency and to compare the costs between blood gases by arterial gasometry (BGA) and capnography in our population. Material and methods: an anamnesis, and respiratory functional tests to assess respiratory muscle involvement, sleep quality were performed.To assess the presence of alveolar hypoventilation the determination of transcutaneous pCO2while awake and/or during sleepwas performed. An economic study has been done to compare the cost of a determination of ptcCO2 versus the determination by BGA. Results: 9 patients with TK2 deficiency (4 adults and 5 children). 4 patients underwent baseline respiratory polygraphy. The pediatric patients underwent at least one continuous recording of ptcCO2 with pulse oximetry each year.4 studies of ptcCO2 duringNIV were performed. The cost in the adult population of a punctual determination of pCO2 by BGA was 6,29 euros while for capnography was 5,37 euros. Conclusions: the measurement of ptcCO2 is useful in the consultation of NIV for the realization of specific measurements in the consultation as for continuous monitoring of this parameter. In our practice of transcutaneous capnography, the punctual determination of transcutaneous pCO2 is cheaper than the BGA. (AU)

Effect of Intensity of Home Noninvasive Ventilation in Individuals With Neuromuscular and Chest Wall Disorders: A Systematic Review and Meta-Analysis of Individual Participant Data

Introduction: Home noninvasive ventilation (NIV), targeting a reduction of carbon dioxide with a combination of sufficient inspiratory support and backup-rate improves outcomes in patients with chronic obstructive pulmonary disease. The aim of this systematic review with individual participant data (IPD) meta-analysis was to evaluate the effects of intensity of home NIV on respiratory outcomes in individuals with slowly progressive neuromuscular (NMD) or chest-wall disorders (CWD). Methods: Controlled, non-controlled and cohort studies indexed between January-2000 and December-2020 were sought from Medline, Embase and the Cochrane Central Register. Outcomes were diurnal PaCO2, PaO2, daily NIV usage, and interface type (PROSPERO-CRD 42021245121). NIV intensity was defined according to the Z-score of the product of pressure support (or tidal volume) and backup-rate. Results: 16 eligible studies were identified; we obtained IPD for 7 studies (176 participants: 113-NMD; 63-CWD). The reduction in PaCO2 was greater with higher baseline PaCO2. NIV intensity per se was not associated with improved PaCO2 except in individuals with CWD and the most severe baseline hypercapnia. Similar results were found for PaO2. Daily NIV usage was associated with improvement in gas exchange but not with NIV intensity. No association between NIV intensity and interface type was found. Conclusion: Following home NIV initiation in NMD or CWD patients, no relationship was observed between NIV intensity and PaCO2, except in individuals with the most severe CWD. The amount of daily NIV usage, rather than intensity, is key to improving hypoventilation in this population during the first few months after introduction of therapy. (AU)

Respiratory Center Function and Its Impact in Obesity Hypoventilation Syndrome Treatment

Introduction: Patients with obesity hypoventilation syndrome (OHS) need treatment with positive pressure either with continuous (CPAP) or double pressure (NIV). The apnea–hypopnea index (AHI) is considered a key data for making therapeutic decisions. We hypothesized that HR may be an useful tool to establish different phenotypes and individualize treatment in patients with OHS. Our objective was to analyze the role of the respiratory center response to hypercapnia (HR) in the adequacy of positive airway pressure therapy. Method: We included subjects with OHS treated with CPAP or NIV according to AHI and baseline pCO2. We analyzed therapeutic effectiveness and treatment changes prioritizing CPAP if AHI>30/h. Therapy was considered adequate if it was effective after two years. HR was measured with the p0.1/pEtCO2 ratio and its capability to select therapy was analyzed. The statistical study was performed by means comparison (Student's t) and multivariate analysis (logistic regression). Results: 67 subjects were included of 68(11) years old, 37 (55%) males, initially 45 (67%) treated with NIV and 22 (33%) with CPAP, one case was excluded and in 25 (38%) the treatment was changed. Finally, CPAP was adequate for 29 subjects (44%) and NIV for 37 (56%). The CPAP group showed AHI 57/h (24) and p0.1/pEtCO2 0.37cmH2O/mmHg (0.23), NIV group AHI 43/h (35) and p0.1/pEtCO2 0.24 (0.15) with p=0.049 and 0.006. In multivariate analysis, p0.1/pEtCO2 (p=0.033) and AHI>30 (p=0.001) were predictors of adequate therapy. Conclusion: Measuring the RH of the respiratory center helps to select the most appropriate treatment for patients with OHS. (AU)

Cluster Analysis of Home Mechanical Ventilation in COPD Patients: A Picture of the Real World and Its Impact on Mortality

Background: Treatment of chronic hypercapnic failure in COPD patients with home noninvasive ventilation (HNIV) remains unclear.Aim: To create a curated cohort of all COPD patients on HNIV in Catalonia, perform a cluster analysis, and evaluate mortality evolution.Study design and methods: This study was a multicenter, observational study including all COPD patients on HNIV on 1st January of 2018. Patients were selected through the Catalan Health Service, and administrative and clinical data were obtained in the previous four years. Principal component analysis of mixed data and hierarchical clustering were performed to identify clusters of patients. Mortality was evaluated from 1 January 2018 until 31 December 2020.Results: A total of 247 patients were enrolled. They were mostly male (78.1%), with a median (SD) age of 70.4 (9.4) years old. In 60%, 55% and 29% of patients, obesity, sleep apnea and heart failure coexisted, respectively. Cluster analysis identified four well-differentiated groups labeled for their clinical characteristics: (1) obese smokers, (2) very severe COPD, (3) sleep apnea and (4) older comorbid males. Patients belonging to Clusters (2) and (4) had a worse prognosis than patients in Clusters (1) and (3).Interpretation: A high heterogeneity in the prescription of HNIV was demonstrated. Cluster analysis identifies four different groups, of which only one had COPD as the main cause of ventilation, while the other three clusters showed a predominance of other comorbidities. This leads to different survival outcomes, including an overlapping phenotype of obesity-related disease and sleep apnea with better survival. (AU)

Beneficio del empleo precoz de la oxigenoterapia nasal de alto flujo (ONAF) en pacientes con neumonía por SARS-CoV-2 / Benefits of early use of high-flow-nasal-cannula (HFNC) in patients with COVID-19 associated pneumonia

Introducción:La COVID-19 grave se asocia con una neumonía bilateral hipoxemiante, que desemboca en la necesidad de ventilación mecánica en un considerable número de pacientes. Hasta la fecha no existen recomendaciones acerca del momento óptimo para el inicio de la ONAF.Pacientes y métodos:Estudio retrospectivo de todos los pacientes ingresados por neumonía por COVID-19 y que precisaron ONAF entre marzo de 2020 y febrero de 2021. Se agruparon los pacientes en función del momento de inicio de la ONAF de acuerdo con la PaFi modificada.Resultados:Se incluyeron 53 pacientes, en 44 se inició la ONAF precozmente y en nueve de ellos se inició tardíamente. No existieron diferencias clínico-epidemiológicas significativas. La utilización precoz de la ONAF se asoció con una disminución de la necesidad de intubación (29,5 vs. 66,6%, p = 0,044), de la estancia hospitalaria (18,8 d vs. 36 d, p = 0,022) y de la mortalidad (22,7 vs. 55,5%, p = 0,061).Conclusiones:El empleo precoz de la ONAF se asocia con una disminución de la necesidad de intubación, de la mortalidad y de la estancia hospitalaria global. (AU)

Introduction:Severe COVID-19 is associated with hypoxemic bilateral pneumonia that leads to mechanical ventilation in a considerable proportion of patients. To the best of our knowledge, there are no recommendations about the best time to initiate high flow nasal cannula (HFNC).Patients and methods:Retrospective study of all patients admitted for COVID-19 pneumonia who required HNFO between March 2020 and February 2021. Patients were grouped in early HNFC or late HNFC, according to the modified Kirby index.Results:53 patients were included. Forty-four of them were included in the early HFNC and 9 in late HNFC. There were no statistically significant clinical-epidemiological differences. Early use of HFNC was associated with a decrease in the need for intubation (29.5 vs. 66.6%, p = 0.044), hospital stay (18.8 d vs. 36 d, p = 0.022) and mortality (22.7 vs. 55.5%, p = 0.061).Conclusions:Early HFNC use is associated with a decrease in the need for intubation, mortality and overall hospital stay. (AU)

Uso del soporte respiratorio no invasivo en pacientes con distrés moderado-severo por SARS-CoV-2. Experiencia en un hospital de segundo nivel / Use of non-invasive respiratory support in patients with moderate-severe distress due to sars-cov-2. Experience in a second level hospital

Objetivo: Describir las características de los pacientes ingresados en una unidad de cuidados respiratorios intermedios (UCRI) creada a raíz de la pandemia, analizar los factores asociados a la supervivencia y techo terapéutico. Material y método: Estudio descriptivo observacional, incluye todos los casos con neumonía por SARS-CoV-2 que requirieron ingreso en UCRI. Variables analizadas: clínicas, analíticas, terapéuticas, supervivencia, soporte respiratorio y evolución oximétrica. Se realizó un análisis univariante para las diferencias según techo terapéutico y supervivencia a 90 días, para la evolución de la SpO2/FiO2 en el tiempo se ajustaron modelos lineales mixtos. Resultados: Participaron 37 pacientes. El 46% no eran candidatos a cuidados críticos. Características asociadas a orden de no intubación de manera significativa: edad más avanzada (p=0,001), mayor índice de Charlson (p=0,003), EPOC (p=0,014) o cáncer (p=0,033). Supervivencia global en UCRI del 58%, según techo terapéutico en no intubables la supervivencia fue del 41% mientras en intubables asciende al 89%. Las variables asociadas a mortalidad fueron mayor edad (p=0,012), mayor índice de Charlson (p=0,030), mayor valor de proteína C reativa (p=0,045), menor nº de linfocitos (p=0,019) y tratamiento con lopinovir/ritonavir (p=0,006). La SpO2/FiO2 media al inicio del soporte respiratorio no invasivo (SRNI) fue 112 (DE:23), el 81% padecían distrés grado moderado-severo. A menor SpO2/FiO2 inicial peor pronóstico (p<0,001), el uso de SRNI mejora de manera progresiva la SpO2/FiO2 a mayor número de horas de uso (p=0,006). Conclusiones: El SRNI en UCRI es seguro, mejora la oxigenación y ofrece opciones terapéuticas en pacientes no intubables.(AU)

Objective: To describe the characteristics of the patients admitted to an intermediate respiratory care unit (UCRI) created as a result of the pandemic, to analyze the factors associated with survival and therapeutic ceiling. Material and metho: Descriptive observational study, includes all cases with SARS-CoV-2 pneumonia that required admission to UCRI. Variables analyzed: clinical, analytical, therapeutic, survival, respiratory support and oximetric evolution. A univariate analysis was performed for the differences according to therapeutic ceiling and survival at 90 days, for the evolution of SpO2/FiO2 over time, mixed linear models were adjusted. Results: 37 patients participated. The 46% of them were not candidates for critical care. Characteristics significantly associated with the order of non-intubation: older age (p = 0.001), higher Charlson index (p = 0.003), COPD (p = 0.014) or cancer (p = 0.033). Overall survival in UCRI 58%, according to the therapeutic ceiling in non-intubable patients, survival was 41%, while in intubable it was 89%. The variables associated with mortality were older age (p = 0.012), higher charlson index (p = 0.030), higher value of reactive protein C (p = 0.045), lower number of lymphocytes (p = 0.019) and treatment with lopinovir/ritonavir (p = 0.006). The mean SpO2/FiO2 at the beginning of non-invasive respiratory support (SRNI) was 112 (SD: 23), 81% suffered from moderate-severe distress. The lower the initial SpO2/FiO2, the worse the prognosis (p <0.001), the use of NIRS progressively improves the SpO2/FiO2 with the greater number of hours of use (p = 0.006). Conclusions: SRNI in UCRI is safe, improves oxygenation and offers therapeutic options in non-intubable patients.(AU)

Effectiveness of CPAP vs. Noninvasive Ventilation Based on Disease Severity in Obesity Hypoventilation Syndrome and Concomitant Severe Obstructive Sleep Apnea / El impacto de la terapia de presión positiva de larga duración en el síndrome de hipoventilación-obesidad en función de la gravedad de la enfermedad

Rationale: Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severity.ObjectiveTo determine if CPAP have similar effectiveness when compared to NIV according to OHS severity subgroups.MethodsPost hoc analysis of the Pickwick randomized clinical trial in which 215 ambulatory patients with untreated OHS and concomitant severe OSA, defined as apnoea-hypopnea index (AHI)≥30events/h, were allocated to NIV or CPAP. In the present analysis, the Pickwick cohort was divided in severity subgroups based on the degree of baseline daytime hypercapnia (PaCO2 of 45–49.9 or ≥50mmHg). Repeated measures of PaCO2 and PaO2 during the subsequent 3 years were compared between CPAP and NIV in the two severity subgroups. Statistical analysis was performed using linear mixed-effects model.Results204 patients, 97 in the NIV group and 107 in the CPAP group were analyzed. The longitudinal improvements of PaCO2 and PaO2 were similar between CPAP and NIV based on the PaCO2 severity subgroups.ConclusionIn ambulatory patients with OHS and concomitant severe OSA who were treated with NIV or CPAP, long-term NIV therapy was similar to CPAP in improving awake hypercapnia, regardless of the severity of baseline hypercapnia. Therefore, in this patient population, the decision to prescribe CPAP or NIV cannot be solely based on the presenting level of PaCO2. (AU)

Introducción: El síndrome de hipoventilación-obesidad (SHO) con apnea obstructiva del sueño (AOS) grave concomitante se trata con CPAPo ventilación no invasiva (VNI) durante el sueño. La VNI es más costosa, pero puede ser beneficiosa porque proporciona soporte ventilatorio; sin embargo, no existen estudios a largo plazo que comparen estas modalidades de tratamiento basándose en la gravedad del SHO.ObjetivoDeterminar si la CPAP tiene una eficacia similar a la VNI según los subgrupos de gravedad del SHO.MétodosAnálisis a posteriori del ensayo clínico aleatorizado Pickwick en el que 215 pacientes ambulatorios con SHO sin tratar y con AOS grave concomitante (definida como un índice de apnea-hipopnea [IAH] ≥ 30 episodios/hora) recibieron tratamiento con VNI o CPAP. En el presente análisis, la cohorte Pickwick se dividió en subgrupos según la gravedad basándose en el grado de hipercapnia diurna al inicio del estudio (PaCO2 de 45-49.9mm Hg o ≥ 50mm Hg). Se compararon las mediciones periódicas de PaCO2 y PaO2 durante los 3 años siguientes entre la CPAP y la VNI entre los dos subgrupos de gravedad. Se realizó un análisis estadístico utilizando un modelo lineal mixto.ResultadosSe analizaron 204 pacientes, 97 en el grupo de VNI y 107 en el grupo de CPAP. Las mejoras lineales de PaCO2 y PaO2 fueron similares entre la CPAP y la NIV según los subgrupos de gravedad en función de la PaCO2.ConclusiónEn los pacientes ambulatorios con SHO y AOS grave concomitante a los que se trató con VNI o CPAP, el tratamiento a largo plazo con VNI resultó similar a la CPAP, en cuanto a la mejora de la hipercapnia en vigilia, independientemente de la gravedad de la hipercapnia de inicio. Por lo tanto, en esta población de pacientes la decisión de prescribir CPAP o VNI no puede basarse exclusivamente en el nivel de partida de PaCO2. (AU)

Impacto de sesiones formativas en el conocimiento sobre la terapia de alto flujo en el área de pediatría / Impact of training sessions on knowledge about high-flow therapy in the pediatric area

Introducción: La terapia de alto flujo se utiliza cada vez más en las unidades pediátricas por su efectividad y seguridad, pero requiere una formación especializada. El objetivo del estudio es analizar el nivel de satisfacción y los conocimientos adquiridos tras un taller formativo sobre cuidados enfermeros en pacientes pediátricos con esta terapia.Sujetos y métodos.Diseño de grupo múltiple mediante cuestionario pre- y posformativo sobre conocimientos del alto flujo y cuestionario sobre el grado de satisfacción. La muestra fueron profesionales y personal en formación asistente al curso.Resultados.Participaron 33 profesionales. La nota previa al curso fue de 3,61 (desviación estándar ± 1,52), y la final, de 5,52 (desviación estándar ± 0,8) (p < 0,001). La satisfacción fue muy alta (90,9%) o alta (6,1%).Conclusión.La formación ha sido satisfactoria y efectiva, y ha aumentado significativamente el nivel de conocimientos. (AU)

Introduction: High-flow therapy is increasingly used in pediatrics units due to its effectiveness and safety, however it requires specialised training. The purpose of this study is to analyze the level of satisfaction and knowledge acquired after a training course on nursing care in pediatric patients with high-flow therapy.Subjects and methods.Multiple group study design via pre- and post-study questionnaires on high-flow knowledge and questionnaire on degree of satisfaction. The sample were professionals and personnel in training who attended the course.Results.33 professionals participated. The grade prior to the course was 3.61 (standard deviation ± 1.52) and the final grade was 5.52 (standard deviation ± 0.80) (p < 0.001). The degree of satisfaction was very high (90.9%) or high (6.1%).Conclusion.The training was satisfactory and effective, significantly increasing the level of knowledge. (AU)

La ventilación mecánica no invasiva durante la atención urgente prehospitalaria / Noninvasive ventilation in prehospital emergencies

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Factores asociados a la mortalidad intrahospitalaria y reingreso en una cohorte tratada con ventilación no invasiva en urgencias extrahospitalarias y hospitalarias: estudio VentilaMadrid / Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study

Objetivo. Describir las características clínicas, evolutivas y los factores pronóstico de una cohorte de pacientes trata- dos con ventilación no invasiva (VNI) en servicios de urgencias extrahospitalarios (SUEH) y hospitalarios (SUH). Método. Estudio de cohortes multicéntrico, prospectivo con inclusión consecutiva de pacientes con edema agudo de pulmón o agudización de enfermedad pulmonar obstructiva crónica tratados con VNI entre noviembre 2018 y noviembre de 2020 en SUEH y SUH de la Comunidad de Madrid. Se recogieron características basales, del episodio agudo, así como variables de resultado incluyendo la mortalidad hospitalaria y el reingreso a 30 días. Resultados. Se incluyeron 317 pacientes, 132 (41,6%) en SUEH y 185 (58,4%) en SUH. Hubo 47 muertes intrahospi talarias (16,3%) y 78 reingresos a los 30 días (28,8%). No hubo diferencias en la mortalidad, pero el grupo VNI-SUEH tuvo menor reingreso a 30 días. En el análisis multivariado la mortalidad intrahospitalaria se asoció con la dependen- cia previa (OR = 2,4; IC 95%: 1,11-5,27) y el SAPS-II bajo-moderado frente al alto-muy alto (OR = 2,69; IC 95%: 1,26- 5,77). En la cohorte extrahospitalaria, la mortalidad intrahospitalaria se asoció con la retirada de la VNI en la transferencia del paciente (OR = 8,57; IC 95%: 2,19-33,60). Los reingresos a los 30 días se asociaron con inicio de VNI en el hospital (OR = 3,24; IC 95%: 2,62-6,45) y dependencia previa (OR = 2,08; IC 95%: 1,02-4,22). Conclusiones. Los pacientes de ambos grupos, SUH y SUEH, tienen un perfil clínico basal similar, aunque con mayor gravedad del episodio en el grupo SUEH. No se encontraron diferencias estadísticamente significativas en la mortalidad intrahospitalaria. Se asociaron a una mayor mortalidad la dependencia, la escala SAPS-II > 52 y la retirada de la VNI. El reingreso se asoció con la dependencia y pertenecer al grupo SUH.

Objective. To describe clinical, outcome, and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs). Methods. Multicenter, prospective cohort study enrolling consecutive patients with acute pulmonary edema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode, and outcome variables, including in-hospital mortality and 30-day readmission. Results. A total of 317 patients were included; 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio [OR], 2.4; 95% CI, 1.11– 5.27) and a low-moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high-very high one (OR, 2.69; 95% CI, 1.26–5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR, 8.57; 95% CI, 2.19–33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV) (OR, 3.24; 95% CI, 2.62–6.45) and prior dependence (OR, 2.08; 95% CI, 1.02–4.22). [...]

Características de la ventilación no invasiva prolongada en los servicios de urgencias hospitalarios y su impacto en la eficacia. Análisis del registro VNICat / Characteristics of prolonged noninvasive ventilation in emergency departments and impact upon effectiveness. Analysis of the VNICat registry

Objetivo: Analizar las características y variables asociadas con la ventilación no invasiva realizada completamente en los servicios de urgencias hospitalarios (VNI-SUH) de manera prolongada y su influencia en la eficacia de la técnica. Diseño Estudio multicéntrico observacional prospectivo de cohorte multipropósito. Ámbito Registro VNICat. Participantes Pacientes en los que se realiza VNI-SUH en 11 hospitales catalanes en los meses de febrero o marzo de 2015.IntervenciónNinguna.VariablesLa variable de estudio fue la VNI-SUH, que en función del tiempo se definió como prolongada o no prolongada. La variable de eficacia fue el éxito de la técnica por mejoría. Resultados Se incluyeron 125 pacientes con una mediana de tiempo de VNI-SUH de 12h, que fue el punto de corte para los 2 grupos comparados. En 60 (48%) la VNI-SUH fue no prolongada (<12h) y en 65 (52%) prolongada (≥12h). La VNI-SUH no prolongada se asoció con la indicación de insuficiencia cardiaca aguda y la prolongada con la presencia de diabetes. Entre la VNI-SUH no prolongada y la prolongada no hubo diferencias en la eficacia, éxito por mejoría del 68,3% y del 76,9%, respectivamente, con un odds ratio ajustado de 1,49 (intervalo de confianza del 95% de 0,61-3,60).Conclusiones La VNI-SUH prolongada es una situación frecuente, pero las variables estudiadas que se asocian a ella son escasas. Su presencia no influyo en el éxito de la VNI. (AU)

Objective: To analyze the characteristics and variables associated with prolonged noninvasive ventilation performed completely in Emergency Departments (NIV-ED) and its influence upon effectiveness. Design A prospective, multicenter, observational multipurpose cohort study was carried out. Setting VNICat Registry. Subjects Patients in which NIV-ED was performed in 11 Catalan hospitals in the months of February or March 2015. Intervention No. Variables The study variable was NIV-ED, which as a function of time was defined as prolonged or not prolonged. The efficacy variable was the success of the technique in terms of patient improvement. Results A total of 125 patients were included, with a median NIV-ED duration of 12hours, which was the cut-off point for the comparator groups. In 60 cases (48%) NIV-ED was not prolonged (<12hours), while in 65 cases (52%) ventilation was prolonged (≥12hours). Non-prolonged NIV-ED was associated to the indication of acute heart failure and prolonged ventilation to the presence of diabetes. There were no differences between non-prolonged and prolonged NIV-ED in terms of efficacy, and the success rate in terms of improvement was 68.3% and 76.9%, respectively, with an adjusted odds ratio of 1.49 (95%CI 0.61-3.60). Conclusions Prolonged NIV-ED is a frequent situation, but few variables associated to it have been studied. The presence of prolonged ventilation did not influence the success rate of NIV. (AU)