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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.
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Subject(s)
Humans , Female , Middle Aged , Sarcoma, Alveolar Soft Part/pathology , Lung Neoplasms/pathology , Sarcoma, Alveolar Soft Part/diagnostic imaging , Hemoptysis/complications , Dyspnea , Weight Loss , Tomography, X-Ray Computed , Bronchoscopy , Positron-Emission Tomography , BiopsyABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Plasma Cell Granuloma, Pulmonary/diagnostic imaging , Plasma Cell Granuloma, Pulmonary/drug therapy , Pulmonary Fibrosis/diagnosis , Smokers , Hypothyroidism/complications , Biopsy, Needle/methods , Plasma Cell Granuloma, Pulmonary/complications , Biomarkers, Tumor , Carcinoma, Squamous Cell/pathology , Adrenal Cortex Hormones/therapeutic useABSTRACT
Introducción: Aunque los beneficios de los programas de rehabilitación respiratoria (RR) en pacientes EPOC han sido demostrados, la adherencia es baja, relacionándose con peores resultados. Objetivo: Identificar las causas de abandono de un programa de RR para EPOC y las características de los pacientes con mala adherencia, haciendo especial énfasis en características funcionales y clínicas. Método: Estudio prospectivo en 83 EPOC desde febrero a noviembre de 2015. Se realizó un programa mixto (fuerza y resistencia) ambulatorio de 36 sesiones. Se facilitó la accesibilidad con ambulancias. Los pacientes fueron divididos en adherentes (acudieron al menos al 70% del programa) o no adherentes (al menos a una sesión). Resultados: Se evaluaron 83 pacientes, de los que 26 fueron excluidos. Un 15,7% rehusó participar. La tasa de abandono fue del 38,5%. Las principales causas fueron tener baja motivación para acudir al gimnasio y problemas de trasporte. El grupo que abandonó el programa presentó una menor capacidad vital forzada (abandonan 58,9% vs. completan 67,8%; p = 0,03), peores resultados en el test de esfuerzo submáximo (abandonan 6,2 min vs. completan 9,2 min; p = 0,02), en W totales (abandonan 42,6 vs completan 56,5; p = 0,03) y en VO2, tanto en ml/min/kg (abandonan 11,4 vs completan 13,6; p = 0,03) como en ml/min (abandonan 839 vs completan 1.020; p = 0,04). Este grupo también presentó mayor uso de esteroides orales (abandonan 23,8% vs completan 2,9%; p = 0,01). Conclusiones: Más de 1/3 de los pacientes abandonan los programas. Las causas principales son relativas a la motivación y el transporte. El perfil de paciente que abandona presenta peores pruebas funcionales, más exacerbaciones, uso de esteroides y tabaquismo
Introduction: While the benefits of pulmonary rehabilitation programs (PR) in COPD have been demonstrated, poor adherence, related with worse clinical outcomes, is common. Objective: The purpose of this study was to examine causes for drop-out during a 12-week multidisciplinary pulmonary rehabilitation program and to investigate the characteristics of patients with poor adherence, with special emphasis on functional and clinical characteristics. Method: A prospective study was performed between February and November 2015 in 83 COPD patients enrolled in an outpatient program of 36 strength +resistance training sessions. Ambulances were provided to facilitate access to the clinic. Patients were divided into: adherent (A) (attended at least 70% of the program) or non-adherent (NA) (at least one session). Results: A total of 83 patients were evaluated and 26 excluded; 15.7% refused to participate. The drop-out rate was 38.5%. The main causes were low motivation and transport problems. Lower forced vital capacity (NA, 58.9% vs A, 67.8%; P = .03), worse results on submaximal exercise test (NA, 6.2 minutes vs A, 9.2 minutes; P = .02), in total distance walked (NA, 42.6 vs A, 56.5; P = .03) and VO2 in ml/min/kg (NA, 11.4 vs A, 13.6; P = .03) and in ml/min (NA, 839 vs A, 1020; P = .04) were found in the non-adherent group. This group also showed higher use of oral steroids (NA, 23.8% vs A, 2.9%; P = .01). Conclusions: More than 1/3 of patients leave programs. The main causes are related to motivation and transport. The patients who dropout are those with worse functional tests, more exacerbations, steroids and smoking habit
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/rehabilitation , Rehabilitation/methods , Patient Dropouts/statistics & numerical data , Patient Compliance/statistics & numerical data , Breathing Exercises/statistics & numerical data , Prospective StudiesABSTRACT
INTRODUCTION: While the benefits of pulmonary rehabilitation programs (PR) in COPD have been demonstrated, poor adherence, related with worse clinical outcomes, is common. OBJECTIVE: The purpose of this study was to examine causes for drop-out during a 12-week multidisciplinary pulmonary rehabilitation program and to investigate the characteristics of patients with poor adherence, with special emphasis on functional and clinical characteristics. METHOD: A prospective study was performed between February and November 2015in 83 COPD patients enrolled in an outpatient program of 36 strength +resistance training sessions. Ambulances were provided to facilitate access to the clinic. Patients were divided into: adherent (A) (attended at least 70% of the program) or non-adherent (NA) (at least one session). RESULTS: A total of 83 patients were evaluated and 26 excluded; 15.7% refused to participate. The drop-out rate was 38.5%. The main causes were low motivation and transport problems. Lower forced vital capacity (NA, 58.9% vs A, 67.8%; P=.03), worse results on submaximal exercise test (NA, 6.2minutes vs A, 9.2minutes; P=.02), in total distance walked (NA, 42.6 vs A, 56.5; P=.03) and VO2 in ml/min/kg (NA, 11.4 vs A, 13.6; P=.03) and in ml/min (NA, 839 vs A, 1020; P=.04) were found in the non-adherent group. This group also showed higher use of oral steroids (NA, 23.8% vs A, 2.9%; P=.01). CONCLUSIONS: More than 1/3 of patients leave programs. The main causes are related to motivation and transport. The patients who dropout are those with worse functional tests, more exacerbations, steroids and smoking habit.
Subject(s)
Lung Diseases/rehabilitation , Patient Dropouts , Adrenal Cortex Hormones/therapeutic use , Aged , Exercise Test , Exercise Tolerance , Female , Humans , Lung Diseases/drug therapy , Lung Diseases/physiopathology , Male , Middle Aged , Motivation , Outpatient Clinics, Hospital , Patient Compliance , Patient Dropouts/statistics & numerical data , Patient Education as Topic , Prospective Studies , Quality of Life , Resistance Training , Smoking , Transportation of PatientsABSTRACT
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