ABSTRACT
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.
ABSTRACT
Las enfermedades pulmonares intersticiales difusas (EPID) son un grupo heterogéneo de entidades en lasque el denominador común es la afectación de la zona anatómica existente entre la membrana basal delepitelio alveolar y el endotelio capilar, conocido como espacio intersticial. El abordaje diagnóstico, las complicacionesque pueden aparecer en la historia natural de estas enfermedades y sus escasas alternativasterapéuticas hacen de ellas un auténtico reto para el clínico. En esta breve revisión se incidirá en los aspectosmás relevantes del manejo de las EPID como son los factores pronósticos, las opciones terapéuticas, incluidoel papel del trasplante pulmonar, y el diagnóstico y tratamiento de dos complicaciones de trascendentalrelevancia en su evolución, como son las exacerbaciones y la hipertensión pulmonar asociada(AU)
Diffuse interstitial lung disease is a heterogeneous group of diseases in which the common denominator isinvolvement of the area between the basement membrane of the alveolar epithelium and the capillaryendothelium, known as the interstitial space. Diffuse interstitial lung disease poses a tremendous challengeto the clinician due to the diagnostic approach, the complications that can appear in the natural history ofthese entities, and the scarcity of available therapeutic resources. This brief review discusses key featuresof the management of diffuse interstitial pulmonary disease, such as prognostic factors, the therapeuticoptions including the role of lung transplantation and the diagnosis and treatment of two complicationswith crucial impact on the clinical course of the disease: exacerbations and associated pulmonaryhypertension(AU)
Subject(s)
Humans , Male , Female , Lung Diseases/diagnosis , Lung Diseases/physiopathology , Lung Diseases/therapy , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/pathology , Lung Diseases, Interstitial/therapy , Hypertension, Pulmonary/complications , Lung Transplantation/rehabilitation , Dyspnea/complications , Pulmonary Fibrosis/complications , Adrenal Cortex Hormones/therapeutic use , Azathioprine/therapeutic use , Sarcoidosis/complications , Histiocytosis, Langerhans-Cell/complications , Histiocytosis, Langerhans-Cell/diagnosisABSTRACT
La evolución clínica y el manejo terapéutico de la enfermedad pulmonar obstructiva crónica (EPOC) puedenverse afectados por la presencia de alguna comorbilidad, lo que además suele contribuir a empeorar elpronóstico. Entre las alteraciones endocrinometabólicas que pueden asociarse a la EPOC, se encuentran ladiabetes mellitus, la osteoporosis, el síndrome metabólico o la malnutrición. Son diversos los posibles mecanismosetiopatogénicos que intervienen en la asociación entre EPOC y diferentes trastornos endocrinometabólicos,como el tabaco y la respuesta infl amatoria sistémica con intervención de diferentes citocinas,entre otros. Por otro lado, los glucocorticoides sistémicos a dosis altas utilizados en el tratamiento de laEPOC grave y de las agudizaciones, supone un factor importante en el riesgo de desarrollar ciertas alteracionesmetabólicas, como la diabetes mellitus y la osteoporosis.En el estudio del paciente con EPOC, es importante identifi car los posibles trastornos endocrinometabólicoscoexistentes, para aplicar medidas de corrección y de prevención. Por lo general, los pacientes se beneficiarán de la inclusión en un programa de rehabilitación respiratoria con ejercicio físico y una dieta equilibrada,además del tratamiento farmacológico oportuno en cada caso. También resultan fundamentalesciertas medidas, como evitar el tabaquismo, el sedentarismo, y realizar el tratamiento correcto de la EPOC(AU)
The clinical course and therapeutic management of chronic obstructive pulmonary disease (COPD) may beaffected by the presence of comorbid diseases, which also usually worsen prognosis. Among theendocrinological and metabolic alterations that can be associated with COPD are diabetes mellitus,osteoporosis, metabolic syndrome and malnutrition. There are several possible etiopathogenic mechanismsthat intervene in the association between COPD and distinct endocrine and metabolic disorders, such assmoking and systemic infl ammation, infl uenced by distinct cytokines among other factors. The high-doseglucocorticosteroids used in the treatment of severe COPD and exacerbations are a major risk factor for thedevelopment of some metabolic alterations such as diabetes and osteoporosis.Study of patients with COPD should identify the possible coexisting endocrinological and metabolicalterations in order to apply preventive measures and treatment. In general, patients benefi t from beingincluded in a respiratory rehabilitation program with physical exercise and a balanced diet, in addition toappropriate drug treatment in each case. Certain measures such as avoiding smoking and sedentariness arealso essential in the correct treatment of COPD(AU)
