BACKGROUND: The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. PATIENTS AND METHODS: This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. RESULTS: A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032). CONCLUSION: Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.
The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.
Antitubercular Agents/adverse effects , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/epidemiology , Tuberculosis, Multidrug-Resistant/drug therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Pharmacovigilance , Prospective Studies
ANTECEDENTES Y OBJETIVO: A pesar del elevado número de fallecimientos, en las instituciones sanitarias no siempre se alcanzan estándares de calidad en el proceso de la muerte. El propósito de este estudio fue evaluar la calidad de la atención sanitaria al final de la vida en pacientes ingresados por patología respiratoria en un hospital de agudos. MATERIAL Y MÉTODO: Estudio transversal descriptivo de periodo en el que se analizaron 80 pacientes fallecidos. Las variables se establecieron atendiendo las disposiciones recogidas en la Ley 2/2010, de 8 de abril, de Derechos y Garantías de la dignidad de la Persona en el Proceso de la Muerte aprobada por el Parlamento Andaluz. RESULTADOS: Alto grado de cumplimiento en la evaluación y tratamiento del dolor (95 %) y en la posibilidad de estar acompañado (93,8 %), frente al bajo cumplimiento en la oferta para el seguimiento domiciliario (3,8 %) e información sobre cuidados paliativos (7,5 %). Mayor calidad en la atención global recibida en pacientes más jóvenes. El género y tipo de patología no arrojó diferencias significativas. CONCLUSIONES: Se detectan áreas de mejoras en la atención al final de la vida que requieren estrategias de implementación multicomponentes que favorezcan cambios en la práctica sanitaria
BACKGROUND AND OBJECTIVE: Although a high proportion of seriously ill patients die in hospital, they do not always receive the high standard of care they require. The purpose of this study was to assess the quality of palliative care provided to seriously ill patients hospitalized for respiratory disease. Study population and methods: A cross-sectional, descriptive study was performed on 80 deceased patients. Variables were established in accordance with the Spanish Law 2/2010, of April 8th, on Personal Rights and Guarantees to Die in Dignity, approved by the Parliament of Andalusia. RESULTS: High adherence to protocols was observed in relation to pain assessment and relief (95 %), and to enabling family members to accompany the patient (93.8 %). In contrast, palliative home care was rarely offered (3.8 %), and scarce information was provided on palliative care (7.5 %). General palliative care improved when patients were younger. No significant differences were observed based on patient gender or type of disease. CONCLUSIONS: Areas for improvement were identified in end-of-life care, which require multicomponent implementation strategies favoring changes in health practice
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , 50230 , Right to Die , Hospice Care/legislation & jurisprudence , Quality of Health Care/standards , Lung Neoplasms/epidemiology , Hospice Care/methods , Cross-Sectional Studies , Pain Management
The World Health Organization launched a global initiative, known as aDSM (active TB drug safety monitoring and management) to better describe the safety profile of new treatment regimens for drug-resistant tuberculosis (TB) in real-world settings. However, comprehensive surveillance is difficult to implement in several countries. The aim of the aDSM project is to demonstrate the feasibility of implementing national aDSM registers and to describe the type and the frequency of adverse events (AEs) associated with exposure to the new anti-TB drugs. Following a pilot study carried out in 2016, official involvement of TB reference centres/countries into the project was sought and cases treated with bedaquiline- and/or delamanid-containing regimens were consecutively recruited. AEs were prospectively collected ensuring potential attribution of the AE to a specific drug based on its known safety profile. A total of 309 cases were fully reported from 41 centres in 27 countries (65% males; 268 treated with bedaquiline, 20 with delamanid, and 21 with both drugs) out of an estimated 781 cases the participating countries had committed to report by the first quarter of 2019.
Antitubercular Agents/adverse effects , Diarylquinolines/adverse effects , Nitroimidazoles/adverse effects , Oxazoles/adverse effects , Tuberculosis, Multidrug-Resistant/drug therapy , Diarylquinolines/administration & dosage , Drug Therapy, Combination , Feasibility Studies , Female , Humans , Male , Nitroimidazoles/administration & dosage , Oxazoles/administration & dosage , Pilot Projects , Tuberculosis/drug therapy , World Health Organization
BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the need to assess arterial blood gases in patients with stable chronic obstructive pulmonary disease (COPD) in accordance with spirometric values. PATIENTS AND METHOD: Transverse study in stable COPD patients with spirometry and pulse oximetry assessment. Specific exclusion criteria were: diagnosis of asthma, sleep apnea syndrome or respiratory failure not due to COPD. Diagnostic of respiratory failure was established when pulse oximetry saturation was < or = 92%; we evaluated the best predicted FEV1 cut-off value. RESULTS: 467 patients (age = 64 [8] yr) were evaluated. FEV1 was 44 (14) % predicted. Two patients (1.5%) with FEV1 > 50 % and 29 patients (23.6%) with FEV1 between 41 and 50% had respiratory failure. Sensitivity (0.98) and rate of false-negative (0.98) at a cut-off of 50% predicted value FEV1 was superior to sensitivity (0.75%) and rate of false-negative (0.87) at a cut-off of 40% predicted value FEV1. CONCLUSIONS: In stable COPD patients, the rate of respiratory failure increases when the predicted value FEV1 is below 50%. Therefore, we recommend this spirometric cut-off to evaluate arterial blood gases.
Forced Expiratory Volume , Pulmonary Disease, Chronic Obstructive/blood , Aged , Female , Humans , Male , Middle Aged , Oximetry , Predictive Value of Tests , Pulmonary Disease, Chronic Obstructive/physiopathology , Spirometry
Fundamento y objetivo: Conocer cuándo debemos realizar gasometría arterial en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable según los valores espirométricos. Pacientes y método: Se ha realizado un estudio transversal en pacientes diagnosticados de EPOC, en fase estable, con espirometría y pulsioximetría. Se excluyó a los pacientes con asma, síndrome de apneas del sueño o insuficiencia respiratoria secundaria a otro proceso. Consideramos insuficiencia respiratoria si la saturación de oxígeno por pulsioximetría era del 92% o menor y analizamos el valor del volumen espiratorio forzado en el primer segundo (FEV1) en porcentaje del teórico que mejor sirve de punto de corte. Resultados: Incluimos a 467 pacientes, con una edad media (desviación estándar) de 64 (8) años y FEV1 medio del 44% (14%). Presentaron insuficiencia respiratoria 2 pacientes (1,5%) con FEV1 mayor del 50% y el 23,6% de los pacientes con FEV1 entre el 41 y el 50%. El punto de corte del FEV1 del 50% presentó una sensibilidad (0,98) y un valor predictivo negativo (0,98) superiores al punto de corte del FEV1 del 40% (sensibilidad de 0,75 y valor predictivo negativo de 0,87). Conclusiones: La proporción de pacientes con EPOC estable con insuficiencia respiratoria aumenta a partir de valores del FEV1 menores del 50%, por lo que aconsejamos realizar gasometría arterial a partir de este punto de corte
Background and objetive: The aim of this study was to evaluate the need to assess arterial blood gases in patients with stable chronic obstructive pulmonary disease (COPD) in accordance with spirometric values. Patients and method: Transverse study in stable COPD patients with spirometry and pulse oximetry assessment. Specific exclusion criteria were: diagnosis of asthma, sleep apnea syndrome or respiratory failure not due to COPD. Diagnostic of respiratory failure was established when pulse oximetry saturation was ¾92%; we evaluated the best predicted FEV1 cut-off value. Results: 467 patients (age = 64 [8] yr) were evaluated. FEV1 was 44 (14) % predicted. Two patients (1.5%) with FEV1 > 50 % and 29 patients (23.6%) with FEV1 between 41 and 50% had respiratory failure. Sensitivity (0.98) and rate of false-negative (0.98) at a cut-off of 50% predicted value FEV1 was superior to sensitivity (0.75%) and rate of false-negative (0.87) at a cut-off of 40% predicted value FEV1. Conclusions: In stable COPD patients, the rate of respiratory failure increases when the predicted value FEV1 is below 50%. Therefore, we recommend this spirometric cut-off to evaluate arterial blood gases
Humans , Blood Gas Analysis , Pulmonary Disease, Chronic Obstructive/physiopathology , Respiratory Insufficiency/diagnosis , Spirometry , Cross-Sectional Studies , Oximetry
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Child , Male , Female , Humans , Gonadal Steroid Hormones , 17-Hydroxysteroid Dehydrogenases , Empyema, Pleural , Mutation , Pleura , Pleural Effusion , Terminology , Disorders of Sex Development , Fibrinolytic Agents
