Incidental pulmonary embolism. Incidence, clinical-radiological features and survival / Tromboembolismo pulmonar incidental. Incidencia, manifestaciones clínico-radiológicas y supervivencia

Objetive: To describe the incidence and features of incidental pulmonary embolism (IPE) and survival of all patients with IPE from January 2012 to December 2014. Rationale: The prevalence of IPE accounts for 1–10% of all pulmonary embolisms (PE). Methods: All radiological reports of computed tomography with intravenous contrast in which the IPE was not suspected were evaluated. The numerical data are expressed by mean and standard deviation (SD); Survival by the Kaplan–Meier analysis and the Log Rank test. Results: We reviewed 7508 reports, detecting 44 patients with IPE (0.6%). Men 64%, age 68 years, pack-year 25, oncological disease 73%, chemotherapy last month before IPE 82%. The predominant histological strain was adenocarcinoma (60%) and epidermoid (20%). The origin of the most common tumor was bronchogenic (27%) and colorectal (14%). The distribution according to the PESI index was mainly I (71%) and II (21%). They received anticoagulation 54%. The location of thrombi was bilateral in 32%. Around 70% were located in main and lobar arteries. Overall survival at one year was more than 70%, being higher in anticoagulated patients (log rank <0.05). Conclusions: The incidence of IPE is low, predominantly in oncological patients. Adenocarcinoma is the predominant strain. Most of them have a low severity index. Survival is higher in anticoagulated patients and higher than in the case of published non-incidental PE.(AU)

Objetivo: Describir la incidencia, características y supervivencia de todos los pacientes con TEPI desde Enero de 2012 hasta Diciembre de 2014. Justificación: La prevalencia de tromboembolismo pulmonar incidental (TEPI) ocurre en el 1–10% de todos los tromboembolismos pulmonares (TEP). Método: Todos los informes radiológicos de tomografía computerizada con contraste intravenoso en los cuales el TEP no era sospechado fueron evaluados. Los resultados numéricos fueron expresados mediante media y desviación estándar; Supervivencia por KaplanMeier y test de LogRank. Resultado: Revisamos 7508 informes detectando 44 pacientes con TEPI (0.6%). Hombres 64%, edad 68 años, índice paquetes-año 25, enfermedad oncológica 73%, quimioterapia el mes previo al TEPI 82%. La estirpe histológica predominante fue adenocarcinoma (60%) y epidermoide (20%). El origen del tumor más frecuente fue broncogénico (27%) y colorrectal (14%). La distribución teniendo en cuenta la escala PESI fue predominantemente I (71%) y II (21%). Recibieron anticoagulación el 54%. La localización del trombo fue bilateral en el 32%. En torno al 70% fueron localizados en arterias principales y lobares. La supervivencia global al año fue mayor del 70%, siendo mayor en pacientes anticoagulados (log rank <0.05). Conclusiones: La incidencia de TEPI es baja, predominantemente en pacientes oncológicos. La mayoría presentaron bajo índice de severidad. La supervivencia es mayor en pacientes anticoagulados y mayor que la publicada para embolismos pulmonares no incidentales.(AU)

Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study).

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) has been associated with cardiovascular events (CVEs), although recent randomized controlled trials have not demonstrated that long-term continuous positive airway pressure (CPAP) prevents CVEs. Our objective was to determine the effect of CPAP on older adults with moderate OSA regarding CVE reduction. METHODS: An observational and multicenter study of a cohort of older adults (> 70 years of age) diagnosed with moderate OSA (apnea-hypopnea index 15.0-29.9 events/h) was conducted. Two groups were formed: (1) CPAP treatment and (2) standard of care. The primary endpoint was CVE occurrence after OSA diagnosis. Association with CPAP treatment was assessed by propensity score matching and inverse weighting probability. Secondary endpoints were incidence of CVE separately and time to first CVE. RESULTS: A total of 614 patients were included. After matching, 236 older adults (111 men, mean age 75.9 ± 4.7 years) with a follow-up of 47 months (interquartile range: 29.6-64.0 months) were considered for primary and secondary endpoint evaluations. Forty-one patients presented at least 1 CVE (17.4%): 20 were in the standard-of-care group (16.9%) and 21 were in the CPAP group (17.8%), with a relative risk of 1.05 (95% confidence interval [CI], 0.60-1.83; P = .43) for CPAP treatment. Inverse probability weighting of the initial 614 patients determined an adjusted relative risk of 1.24 (95% CI, 0.79-1.96; P = .35) for CPAP treatment. No statistical differences were found in secondary endpoint analyses. CONCLUSIONS: CPAP should not be prescribed to reduce CVE probability in older adults with moderate OSA. CITATION: López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, et al. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study). J Clin Sleep Med. 2022;18(2):553-561.

High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19.

INTRODUCTION: High-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2. METHODS: A retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation. RESULTS: In the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO2/FiO2 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5.0±1.6 vs 4.0±1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 - 13.7]; p=0.026). CONCLUSION: High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.