RESUMEN
INTRODUCTION: Sedation during endobronchial ultrasound (EBUS) is essential due to the long duration of this procedure. We evaluated different models of sedation and their complications. METHOD: A multicenter, prospective, observational study of 307 patients undergoing EBUS was conducted. Patients were sedated with: a) midazolam bolus; b) propofol infusion; c) midazolam bolus and propofol infusion; d) propofol infusion and remifentanil infusión, or e) midazolam bolus and fentanyl bolus, and clinical variables were collected. Patients were asked to complete a satisfaction survey following the test. RESULTS: Patients per sedation model were: A 24, B 37, C 107, D 62 and E 77. Scores for perceived sensations of recall, pain, cough, dyspnea and prolonged examination (0.65±1.11; 0 3±0.73, 0.46±0.9, 0.29±0.73, and 0.59±0.96, respectively) were lower compared to fear and nervousness before the examination (1.26±1.37 and 1.5±1.41, respectively). High levels of indifference to repeating the procedure (1.49±1.3) and a reported pleasant feeling during the test (1.23±1.17), with low levels of anxiety (0.49±0.85) and discomfort (0.62±1.1), show that different models of sedation were well tolerated. Almost half the patients (46.6%) did not report any "worst moment" during the procedure, and 89.6% were willing to undergo a repeat test. The E and C models presented fewest complications (12.9 and 31.7%, respectively), and all were resolved with simple therapeutic measures. CONCLUSIONS: The models of sedation evaluated were well tolerated and most patients were willing to undergo repeat EBUS. Complications were few and easily resolved.
Asunto(s)
Broncoscopía , Sedación Consciente , Sedación Profunda , Endosonografía , Adulto , Anciano , Anciano de 80 o más Años , Broncoscopía/efectos adversos , Sedación Consciente/efectos adversos , Sedación Profunda/efectos adversos , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Masculino , Persona de Mediana Edad , Modelos Teóricos , Satisfacción del Paciente , Estudios ProspectivosRESUMEN
BACKGROUND: Although some authors have suggested that there is some seasonal periodicity in hemoptysis, temporal patterns of hemoptysis have been poorly investigated. The aim of this study is to describe the temporal pattern of severe hemoptysis which required bronchial artery embolization (BAE). METHODS: All consecutive patients with at least one episode of hemoptysis which required BAE during a 13-year period were included. Recurring hemoptysis requiring BAE in a patient with previous embolization was included as a new hemoptysis event, unless it occurred within one month from the prior event. Lineal regression was applied to compute the tendency of occurrence of cases along 13 years of record data. The daily and monthly distributions of embolizations were used to study the weekly and monthly seasonal indexes. RESULTS: Hemoptysis requiring BAE occurred with some monthly variation demonstrated with two monthly peaks, with the first one occurring during April and the second one during November. CONCLUSION: Hemoptysis occurred with two monthly peaks. This seasonal trend might be due to different prevalence of respiratory tract infections or to some weather variables. Identification of significant environmental factors could be useful to improve preventive measures.
RESUMEN
Introducción: La sedación durante la ecobroncoscopia es importante debido a la duración prolongada de esta exploración. Evaluamos distintos modelos de sedación y sus complicaciones. Método: Se realizó un estudio multicéntrico, prospectivo y observacional en el que recogieron distintas variables en 307 pacientes con distintos modelos de sedación: a) midazolam en bolo; b)propofol en perfusión; c) midazolam en bolo y propofol en perfusión; d) propofol en perfusión y remifentanilo en perfusión, y e) midazolam en bolo y fentanilo en bolo. Finalizada la prueba, los pacientes contestaron una encuesta de satisfacción. Resultados: Los pacientes por modelo de sedación fueron: A 24, B 37, C 107, D 62 y E 77. Las puntuaciones de las sensaciones percibidas de recuerdo, dolor, tos, disnea y exploración prolongada (0,65 ± 1,11; 0,3 ± 0,73; 0,46 ± 0,9; 0,29 ± 0,73; 0,59 ± 0,96) fueron menores frente a miedo y nerviosismo antes de la exploración (1,26 ± 1,37 y 1,5 ± 1,41). Los valores elevados de indiferencia ante la repetición (1,49 ± 1,3) y de sensación agradable de la prueba (1,23 ± 1,17), junto con cifras bajas la sensación de angustia (0,49 ± 0,85) e incomodidad de la exploración (0,62 ± 1,1), muestran que los distintos modelos de sedación fueron bien tolerados. El 46,6% de los pacientes no encontraron ningún momento malo y el 89,6% se repetiría la prueba. Los modelos E y C fueron los que menos complicaciones presentaron (12,9 y 31,7%) y, en todos los casos, se resolvieron con medidas terapéuticas sencillas. Conclusiones: Los modelos de sedación analizados fueron bien tolerados y la mayoría aceptarían la repetición de la ecobroncoscopia. Las complicaciones fueron escasas y sencillas de resolver
Introduction: Sedation during endobronchial ultrasound (EBUS) is essential due to the long duration of this procedure. We evaluated different models of sedation and their complications. Method: A multicenter, prospective, observational study of 307 patients undergoing EBUS was conducted. Patients were sedated with: a) midazolam bolus; b) propofol infusion; c) midazolam bolus and propofol infusion; d) propofol infusion and remifentanil infusión, or e)midazolam bolus and fentanyl bolus, and clinical variables were collected. Patients were asked to complete a satisfaction survey following the test. Results: Patients per sedation model were: A 24, B 37, C 107, D 62 and E 77. Scores for perceived sensations of recall, pain, cough, dyspnea and prolonged examination (0.65 ± 1.11; 0 3 ± 0.73, 0.46 ± 0.9, 0.29 ± 0.73, and 0.59 ± 0.96, respectively) were lower compared to fear and nervousness before the examination (1.26 ± 1.37 and 1.5 ± 1.41, respectively). High levels of indifference to repeating the procedure (1.49±1.3) and a reported pleasant feeling during the test (1.23±1.17), with low levels of anxiety (0.49 ± 0.85) and discomfort (0.62 ± 1.1), show that different models of sedation were well tolerated. Almost half the patients (46.6%) did not report any "worst momento" during the procedure, and 89.6% were willing to undergo a repeat test. The E and C models presented fewest complications (12.9 and 31.7%, respectively), and all were resolved with simple therapeutic measures. Conclusions: The models of sedation evaluated were well tolerated and most patients were willing to undergo repeat EBUS. Complications were few and easily resolved
Asunto(s)
Humanos , Masculino , Femenino , Sedación Profunda/instrumentación , Sedación Profunda/métodos , Sedación Profunda , Broncoscopía/métodos , Broncoscopía , Sedación Profunda/clasificación , Sedación Profunda/normas , Sedación Profunda/tendencias , Seguridad/normas , Midazolam/uso terapéutico , Propofol/uso terapéutico , Fentanilo/uso terapéutico , Estudios ProspectivosAsunto(s)
Bronquiolitis Obliterante/inducido químicamente , Quelantes/efectos adversos , Degeneración Hepatolenticular/tratamiento farmacológico , Penicilamina/efectos adversos , Bronquiolitis Obliterante/diagnóstico por imagen , Bronquiolitis Obliterante/tratamiento farmacológico , Bronquiolitis Obliterante/patología , Bronquiolitis Obliterante/cirugía , Broncodilatadores/uso terapéutico , Quelantes/uso terapéutico , Terapia por Quelación/efectos adversos , Terapia Combinada , Cobre , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Enfermedad de Graves/complicaciones , Enfermedad de Graves/radioterapia , Degeneración Hepatolenticular/complicaciones , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Trasplante de Pulmón , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Penicilamina/uso terapéutico , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Tomografía Computarizada por Rayos XRESUMEN
No disponible
Asunto(s)
Humanos , Bronquiolitis Obliterante/inducido químicamente , Encefalina D-Penicilamina (2,5)/efectos adversos , Factores de RiesgoRESUMEN
No disponible