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
No disponible
Child , Male , Female , Humans , Gonadal Steroid Hormones , 17-Hydroxysteroid Dehydrogenases , Empyema, Pleural , Mutation , Pleura , Pleural Effusion , Terminology , Disorders of Sex Development , Fibrinolytic Agents
BACKGROUND AND OBJECTIVES: The purpose of this study was: 1) To determine the effect of non invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure, and 2) To find out whether there are differences in the results according to the site where ventilation in applied. PATIENTS AND METHOD: Meta-analysis of randomized controlled trials (RCTs) published included studies in MEDLINE, EMBASE, Cochrane Controled Trials Register and Teseo. Study selection included RCTs in COPD patients with acute respiratory failure with PaCO2 > 45 mmHg or pH < 7.35, with underwent NIV versus standard therapy. Mortality, rate of tracheal intubation and length of stay were analized. Individual studies were rated as to their validity and quality by two investigators using the Jadad score. A different meta-analysis was made for intensive-care unit (ICU) RCTs and wards RCTs. RESULTS: Five ICU RCTs and four ward RCTs were included. There was a reduction in hospital mortality (ICU, OR = 0.35; 95% confidence interval [CI], 0.15 to 0.83; n = 166; p = 0.02; ward, OR = 0.39; 95% CI, 0.20 to 0.76; n = 296; p = 0.005) and in the need for intubation (ICU, OR = 0.18; 95% CI, 0.10 to 0.35; n= 219; p < 0,00001; ward, OR = 0.43; IC 95%, 0.24-0.78; n = 270; p = 0.006). Length of stay was lower in the NIV group upon ICU trials (WMD, 3.7 days; 95% CI, 5.46 to 1.93 days). Only one ward RCT showed significant differences in the length of stay. Published data did not allow a meta-analysis for length of stay. CONCLUSIONS: NIV decreases mortality and the need for intubation in COPD patients with acute respiratory failure both in ICU and ward. In ICU non-invasive ventilation decreases the length of stay too.
Pulmonary Disease, Chronic Obstructive/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Acute Disease , Humans , Pulmonary Disease, Chronic Obstructive/complications , Randomized Controlled Trials as Topic , Respiratory Insufficiency/etiology
FUNDAMENTO Y OBJETIVOS: Valorar la eficacia de la ventilación no invasiva (VNI) en la enfermedad pulmonar obstructiva crónica (EPOC) en fracaso respiratorio agudo (FRA) y saber si hay diferencias en los resultados en función del lugar de aplicación. MATERIAL Y MÉTODO: Se realizó un metaanálisis de ensayos controlados aleatorizados (ECA) publicados en Medline, EMBASE, Registro de Ensayos Clínicos Controlados de la Colaboración Cochrane y Teseo hasta junio de 2002. Se efectuó una selección de los ECA en EPOC con FRA y pH sanguíneo 45 mmHg, con VNI frente a tratamiento estándar, y se analizaron mortalidad, tasa de intubación y días de estancia. La validez y calidad de los ECA fueron analizadas por dos investigadores con la escala de Jadad. Realizamos metaanálisis diferentes para los estudios de unidades de cuidados intensivos (UCI) y planta. RESULTADOS: Se incluyeron 5 ECA de UCI y 4 de planta. Se encontró una reducción de la mortalidad (UCI, odds ratio [OR] = 0,35; intervalo de confianza [IC] del 95 por ciento, 0,15-0,82; n = 166; p = 0,02; planta, OR = 0,40; IC del 95 por ciento, 0,21-0,75; n = 330; p = 0,005) y del número de intubaciones (UCI, OR = 0,18; IC del 95 por ciento, 0,10-0,35; n = 219; p < 0,00001; planta, OR = 0,43; IC del 95 por ciento, 0,24-0,78; n = 270; p = 0,006). La estancia media fue menor en UCI (diferencia media ponderada de -3,7 días; IC del 95 por ciento, -5,46 a -1,93; n = 196; p = 0,00004).Sólo un ECA de planta demostró diferencias entre ambos grupos en la estancia media; los datos publicados no permitieron realizar metaanálisis acerca de la estancia. CONCLUSIONES: La VNI reduce la mortalidad y la necesidad de intubación en pacientes con EPOC en FRA cuando se aplica tanto en UCI como en planta. En la UCI la VNI reduce también los días de hospitalización (AU)
Middle Aged , Adult , Aged , Aged, 80 and over , Male , Female , Humans , Intensive Care Units , Enterococcus faecalis , Vancomycin , Urinary Tract Infections , Critical Illness , Incidence , Gram-Positive Bacterial Infections , Prospective Studies , Respiration, Artificial , Respiratory Insufficiency , Pulmonary Disease, Chronic Obstructive , Anti-Bacterial Agents , Cross Infection , Acute Disease , Randomized Controlled Trials as Topic
