Diagnostic Assessment of Respiratory and Hemodynamic Changes Related to Prone Position in COVID-19 Patients.

OBJECTIVE: To study the respiratory patterns and the hemodynamic variations related to postural changes in inpatients with coronavirus disease (COVID-19). METHODS: This report is a prospective study in a cohort of inpatients admitted with COVID-19. We recruited 10 patients admitted to the hospital with moderate or severe COVID-19 who showed improvement in oxygen saturation with prone positioning. We performed cardiorespiratory polygraphy and hemodynamic evaluations by thoracic electrical bioimpedance. RESULTS: We observed a median minimum oxygen saturation of 85.00% (IQR: 7.00) in the supine position versus 91.00% (IQR: 8.00) (P = 0.173) in the prone position. The airflow restriction in the supine position was 2.70% (IQR: 6.55) versus 1.55% (IQR: 2.80) (P = 0.383) in the prone position. A total of 36.4% of patients were classified as having a normo-hemodynamic state in the supine position, whereas 54.5% were classified in this group in the prone position (P = 0.668). A decrease in vascular resistance was observed in the prone position (18.2% of vasoconstriction) compared to the supine position (36.4% of vasoconstriction) (P = 0.871). CONCLUSION: This brief report describes the effects of prone positioning on respiratory and hemodynamic variables in 10 patients with moderate or severe COVID-19.

Increased Oxygen Desaturation Time During Sleep Is a Risk Factor for NASH in Patients With Obstructive Sleep Apnea: A Prospective Cohort Study.

Introduction: Given that obstructive sleep apnea (OSA) is commonly associated with metabolic disorders, in this prospective study, we sought to determine the prevalence and risk factors for hepatosteatosis, non-alcoholic steatohepatitis (NASH), and advanced liver fibrosis in patients with clinical and polygraphic criteria of OSA (n = 153) and in subjects with normal lung function parameters (NLP, n = 43). Methods: Hepatosteatosis, NASH, and advanced liver fibrosis were determined by blood-based non-invasive tools, such as the fatty liver index and the hepatic steatosis index, a serum lipidomic (OWLiver™) test, and three distinct fibrosis algorithms, respectively. Logistic regression models adjusted by potential confounders were performed to evaluate risk factors. Results: Insulin resistance and dyslipidemia were more frequent in patients with OSA than in subjects with NLP. The prevalence of hepatosteatosis was significantly higher in patients with OSA than in subjects with NLP. NASH was also found more frequently in patients with OSA than in subjects with NLP. In contrast, advanced liver fibrosis was rarely detected in the entire study population, and no significant differences were observed between patients with OSA and subjects with NLP. Besides male gender, increased body mass index (BMI), and presence of type 2 diabetes, percentage of sleep time with oxygen saturation <90% (Tc90%) was the only polygraphic variable significantly associated with NASH in patients with OSA. Conclusions: This study shows that hepatosteatosis and NASH are highly prevalent in patients with OSA and indicates that those with a Tc90% higher than 10% are at increased risk for NASH.

Limitación terapéutica en pacientes ancianos: reflexiones a propósito del COVID-19 / Therapeutic Limitation in Elderly Patients: Reflections Regarding COVID19

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Oleotórax bilateral / Bilateral Oleothorax

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Réplica. Lipoma endobronquial: una causa infrecuente de obstrucción bronquial / Reply. Endobronchial Lipoma: An Unusual Cause of Bronchial Obstruction

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Ventilación mecánica no invasiva en una población anciana que ingresa en una unidad de monitorización respiratoria: causas, complicaciones y evolución al año de seguimiento / Non-invasive Ventilation in an Elderly Population Admitted to a Respiratory Monitoring Unit: Causes, Complications and One-year Evolution

Objetivo: Determinar la utilidad de la ventilación mecánica no invasiva (VMNI) en pacientes ancianos (≥75 años) que ingresan en una unidad de monitorización respiratoria (UMR) durante el ingreso y al año del alta. Comparamos los resultados con el grupo de pacientes de menor edad (<75 años). Material y métodos: Estudio prospectivo observacional realizado en el Hospital La Princesa (Madrid, España). Se reclutaron todos los pacientes ≥75 años que ingresaron en nuestra UMR en acidosis respiratoria (pH <7,35 y PaCO2 >45mmHg) y que recibieron tratamiento con VMNI. Se recogieron variables relativas a características sociodemográficas y de la vida basal, antecedentes patológicos previos, motivos de ingreso y gravedad, datos analíticos al ingreso y evolución gasométrica al inicio de la VMNI, en la primera hora y tras 24h, complicaciones y evolución al año de seguimiento. Resultados: La edad media fue de 80,6 años. El índice de Charlson fue de 3,27. Aproximadamente la mitad de los pacientes presentaban alguna limitación para las actividades de la vida diaria. Los principales motivos de ingreso fueron la agudización de la EPOC y la insuficiencia cardíaca. En 36 casos se registraron complicaciones (11 insuficiencia renal, 6 fibrilación auricular). La supervivencia al año del seguimiento fue del 63,21%. Conclusiones: La VMNI es una buena alternativa en pacientes ancianos que ingresan en acidosis respiratoria. No detectamos diferencias en la mortalidad durante el ingreso con el grupo <75 años. Los pacientes ancianos ingresan más entre los 6-12 meses posteriores al alta, y esto podría deberse a una peor situación funcional tras un ingreso que requiere VMNI(AU)

Objective: To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and one year later in comparison with the results from the younger age group (<75). Material and methods: Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH <7.35 and PaCO2 >45mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24hours), complications and evolution at the one-year follow-up. Results: Mean age of the sample was 80.6 years. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the one-year follow-up was 63.21%. Conclusions: NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV(AU)

Non-invasive ventilation in an elderly population admitted to a respiratory monitoring unit: causes, complications and one-year evolution.

OBJECTIVE: To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and 1 year later in comparison with the results from the younger age group (<75). MATERIAL AND METHODS: Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH<7.35 and PaCO(2)>45 mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24 h), complications and evolution at the 1-year follow-up. RESULTS: Mean age of the sample was 80.6. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the 1-year follow-up was 63.21%. CONCLUSIONS: NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV.

Estudio de la prevalencia y actitudes sobre tabaquismo en pacientes sometidos a oxigenoterapia crónica domiciliaria. Estudio toma / Study of Prevalence and Attitudes on Smoking in Patients on Continuous Home Oxygen Therapy. Toma Study

IntroducciónEl objetivo de este estudio ha sido analizar la prevalencia, las actitudes y las características del tabaquismo en la población de pacientes sometidos a oxigenoterapia crónica domiciliaria (OCD) en la Comunidad de Madrid.Pacientes y métodosDe un total de 11.174 sujetos que cumplían los criterios de inclusión, se obtuvo una muestra representativa de 845 sujetos. De ellos 461 (54,6%) eran hombres. La edad media fue de 78,25 años [IC95%:77,55–78,95; Dt=10,36]. Se realizó un estudio descriptivo transversal basado en cuestionarios y acompañado de cooximetría.Resultados48 sujetos (5,7%; IC95%: 4,3–7,5%) eran fumadores y 438 (51,8%; IC95%: 48,5–55,2%) exfumadores. La tasa de fumadores activos fue más alta en el grupo de sujetos con 60 o menos años (χ2; p<0,001). El 75% de los fumadores fueron hombres siendo significativamente mayor su proporción que en los no fumadores actuales (χ2; p=0,003). La puntuación media en el test de Fagerström fue 3,6. Más del 65% de los fumadores consumían el primer cigarrillo a los 30 después de levantarse. El 45% de ellos se encontraban en fase de preparación. Un 17% de estos sujetos refirió no haber recibido consejo de abandono del tabaco.ConclusionesAlta tasa de tabaquismo en pacientes en OCD, con mayor probabilidad de persistencia del hábito tabáquico entre los varones y los más jóvenes. El 17% de los fumadores no reconoce haber sido alertado sobre la necesidad de abandonar el tabaco. Alto grado de dependencia física por la nicotina(AU)

IntroductionThe objective of this study is to analyse the prevalence, attitudes and characteristics of smoking in the population of patients subjected to Long Term Domiciliary Oxygen Therapy (LTDOT) in the Community of Madrid.Patient and methodsA representative sample of 845 subjects (of which 461 (46%) were male) was obtained from a total of 11,174 who fulfilled the inclusion criteria. The mean age was 78.25 years (95% Confidence Interval (CI): 77.55–78.95; SD=10.36). A descriptive cross-sectional study was conducted based on questionnaires as well as cooximetry.ResultsForty-eight subjects (5.7%; 95%CI: 4.3%–7.5%) were smokers and 438 (51.8%; 95%CI: 48.5%–55.2%) were ex-smokers. The percentage of active smokers was higher in the 60 years or less subject group (χ2; P<0.001). The large majority (75%) of smokers were men, their proportion being significantly higher than that of current non-smokers (χ2; P<0.003). The mean score in the Fagerström Test was 3.6. More than 65% of smokers had their first cigarette up to 30min from getting up in the morning, and 45% of these were in a preparation phase. Seventeen percent of these subjects said that they had not received advice on quitting smoking.ConclusionsThere is a high rate of smoking in patients on LTDOT, with a higher probability of males and younger subjects continuing to smoke. There is a high level of physical dependency for nicotine(AU)

[Study of prevalence and attitudes on smoking in patients on continuous home oxygen therapy. Toma study]. / Estudio de la prevalencia y actitudes sobre tabaquismo en pacientes sometidos a oxigenoterapia crónica domiciliaria. Estudio toma.

INTRODUCTION: The objective of this study is to analyse the prevalence, attitudes and characteristics of smoking in the population of patients subjected to Long Term Domiciliary Oxygen Therapy (LTDOT) in the Community of Madrid. PATIENT AND METHODS: A representative sample of 845 subjects (of which 461 (46%) were male) was obtained from a total of 11,174 who fulfilled the inclusion criteria. The mean age was 78.25 years (95% Confidence Interval (CI): 77.55-78.95; SD=10.36). A descriptive cross-sectional study was conducted based on questionnaires as well as cooximetry. RESULTS: Forty-eight subjects (5.7%; 95%CI: 4.3%-7.5%) were smokers and 438 (51.8%; 95%CI: 48.5%-55.2%) were ex-smokers. The percentage of active smokers was higher in the 60 years or less subject group (χ(2); P<0.001). The large majority (75%) of smokers were men, their proportion being significantly higher than that of current non-smokers (χ(2); P<0.003). The mean score in the Fagerström Test was 3.6. More than 65% of smokers had their first cigarette up to 30 min from getting up in the morning, and 45% of these were in a preparation phase. Seventeen percent of these subjects said that they had not received advice on quitting smoking. CONCLUSIONS: There is a high rate of smoking in patients on LTDOT, with a higher probability of males and younger subjects continuing to smoke. There is a high level of physical dependency for nicotine.