[All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic]. / Todos los caminos llevan a Roma: resultados de las terapias respiratorias no invasivas aplicadas en un centro terciario sin Unidad de Cuidados Intermedios durante la pandemia de COVID-19.

Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain.

BACKGROUND: Bronchial thermoplasty (BT) is a minimally invasive procedure consisting of application of thermal energy into the airways to produce ablation of the hypertrophic smooth muscle. It was approved for use in moderate-severe asthma in Spain in 2010. OBJECTIVES: The aims of the present study are to analyze the effectiveness and the safety of BT in clinical practice in our center. METHODS: Participants had a confirmed diagnosis of severe asthma and poor control without therapeutic alternative. Effectiveness was measured by comparing exacerbations, admissions rates, asthma control, and medication 1 year prior and 1 year after BT was completed. All complications appearing during the procedure and in the first year were recorded. RESULTS: Patients had a mean age of 51 (SD 8) years and were predominantly female (17/23). The average number of activations per patient was 147 (16). The number of severe exacerbations was reduced by 75% (p < 0.001). A 38% reduction in admissions per year was also observed (p = 0.03). The Asthma Control Test improved by 7.1 (3.7) points (p = 0.018). Before BT, the dose of inhaled corticosteroids was 1,621 (1,015) µg of budesonide-equivalent and the dose of oral corticosteroids was 15 (13) mg of prednisone-equivalent. There was a reduction in 430 (731) µg of budesonide-equivalent (p = 0.02) and 4 (11) mg of prednisone (p = 0.094). No changes in lung function were observed. Complications were related mostly to exacerbation of asthma in the days following the procedure. CONCLUSIONS: BT is effective and safe for severe uncontrolled bronchial asthma in real clinical practice.

Lung function tests in clinical decision-making.

In this article, we review the utility of the most common lung function tests (spirometry, reversibility test, peak expiratory flow, lung volumes, maximal respiratory pressure, carbon monoxide transference, arterial blood gas, 6-minute walk test and desaturation with exercise and ergospirometry) related to the most frequent pathologies (dyspnea of undetermined origin, chronic cough, asthma, COPD, neuromuscular diseases, interstitial diseases, pulmonary vascular diseases, pre-operative evaluation and disability evaluation). Our analysis has been developed from the perspective of decision-making, clinical interpretation or aspects that the physician should take into account with their use. Consequently, the paper does not deal with aspects of quality, technique or equipment, with the exception of when regarding costs as we believe that this is an important element in the decision-making process. The document is extensively supported by references from the literature.

Dyspnea, ventilatory pattern, and changes in dynamic hyperinflation related to the intensity of constant work rate exercise in COPD.

STUDY OBJECTIVE: We undertook the present study to investigate the perception of dyspnea (with respect to changes in end-inspiratory and end-expiratory lung volumes), during four different levels of high-intensity constant work rate exercise (CWRE) in patients with severe COPD. DESIGN: Crossover descriptive study with consecutively recruited subjects. SETTING: Tertiary university hospital. PATIENTS: Twenty-seven subjects with severe COPD (mean [+/- SD] age, 65 +/- 5 years of age; mean FEV1, 43 +/- 8% predicted; and mean inspiratory capacity [IC]; 74 +/- 14% predicted). MEASUREMENTS AND RESULTS: Subjects randomly performed four high-intensity CWRE tests (conducted at 65%, 75%, 85%, and 95% of their symptom-limited peak work rate). Dyspnea, leg fatigue, and IC were determined every 2 min during exercise with breath-by-breath gas exchange and ventilatory measurements. There was a good correlation between the resting IC percent predicted and the oxygen uptake (V(O2)) peak (r = 0.64 to 0.69 between the IC percent predicted and V(O2) peak at the four work rates). There were significant differences (p < 0.01) in mean respiratory rate (33 +/- 6, 35 +/- 6, 37 +/- 6, and 38 +/- 6 min), peak dyspnea score (5.9 +/- 1.3, 6.3 +/- 1.4, 6.8 +/- 1.2, and 6.9 +/- 1.6), minute ventilation (45.0 +/- 8.7, 43.8 +/- 7.7, 43.1 +/- 8.7, and 42.8 +/- 8.0 L/min), leg fatigue (4.8 +/- 1.3, 5.1 +/- 1.3, 5.7 +/- 1.4, and 5.8 +/- 1.4), and end-tidal carbon dioxide partial pressure (4.41 +/- 0.36, 4.53 +/- 0.33, 4.66 +/- 0.31, and 4.76 +/- 0.24 kPa), respectively, for tests conducted at 65%, 75%, 85%, and 95% of their symptom-limited peak work rate, and in mean end-expiratory lung volume ([EELV] 4.55 +/- 0.44, 4.69 +/- 0.43, and 4.79 +/- 0.43 L), respectively, for tests conducted at 65%, 75%, and 85% of their symptom-limited peak work rate. In multivariable analysis, the factors that were independently correlated with dyspnea (p < 0.05) were EELV, peak inspiratory flow, and leg fatigue/discomfort. CONCLUSION: In COPD subjects with flow limitation at rest, the perception of dyspnea increased nonlinearly with the magnitude of high-intensity CWRE in association with a faster respiratory pattern and an increase in EELV. At the highest work rates, it appeared that a reduction in tidal volume and ventilation peak may have limited the tolerance to exercise.