Changes in Oxygen Saturation During Fiberoptic Bronchoscopy: High-Flow Nasal Cannula versus Standard Oxygen Therapy.

BACKGROUND: Hypoxemia is a relatively common complication in stable patients during fiberoptic bronchoscopy (FOB). To prevent this complication, high-flow nasal cannula (HFNC) has been described as an alternative to standard oxygen therapy. However, the advantages of HFNC over standard oxygen therapy in acute care patients receiving supplemental oxygen before FOB performed with an oral approach are unknown. METHODS: We conducted an observational study that involved subjects with a presumptive diagnosis of pneumonia and a clinical indication for a bronchial aspirate sample. The type of oxygen support (standard oxygen therapy vs HFNC) was selected according to availability. The oxygen flow in the HFNC group was 60 L/min. In both groups, the FIO2 was set at 0.40. Hemodynamic, respiratory dynamics, and gas exchange data were collected at baseline, before, during, and 24 h after FOB. RESULTS: Forty subjects were included, 20 in each group (HFNC and standard oxygen therapy). The study was performed on day 5 of hospitalization in the HFNC group and on day 4 in the standard oxygen therapy group (P = .10). No significant between-group differences in baseline characteristics were observed. HFNC vs standard oxygen therapy was associated with a smaller decrease in SpO2 levels during the procedure (94% vs 90%; P = .040, respectively) and with less variation between the last SpO2 measured before FOB and the lowest SpO2 during FOB (Δ SpO2 ): 2% versus 4.5% (P = .01, respectively). CONCLUSIONS: In acute subjects who required oxygen support before FOB, the use of HFNC during FOB with an oral approach was associated with a smaller decrease in SpO2 and lower Δ SpO2 compared with standard oxygen therapy.

Morbimortalidad en Pacientes con Diagnóstico de Fractura de Cadera Atendidos en el Hospital de Especialidades José Carrasco Arteaga, 2015 / Morbidity and Mortality of Patients Diagnosed with Hip Fracture at José Carrasco Arteaga Specialties Hospital. 2015

INTRODUCCIÓN: La incidencia de fractura de cadera en el Ecuador se estima en 314 casos por 100.000 habitantes al año. El objetivo del presente estudio fue establecer la incidencia y factores de riesgo asociados a morbimortalidad en pacientes con diagnóstico de fractura de cadera. MÉTODO: Estudio retrospectivo y analítico de cohorte que estudió la incidencia y riesgo asociado a morbimortalidad. Se incluyeron todos los pacientes diagnosticados con fractura de cadera que fueron tratados en el Hospital de Especialidades José Carrasco Arteaga durante el año 2015. Para el análisis se utilizó la estadística básica descriptiva, chi-cuadrado y análisis de riesgo relativo con un intervalo de confianza al 95% (p: <0.05) para determinar significancia estadística. RESULTADOS: Se estudiaron 81 pacientes. Las complicaciones más frecuentes fueron: infección del sitio quirúrgico (13.58 %), neumonía (12.34 %) y fallo de osteosíntesis (9.87 %). La mortalidad general fue de 32.1 %. Los pacientes con dos o más complicaciones tuvieron casi dos veces más riesgo de fallecimiento (RR: 2.94; IC ­ 95 %: 1.78 ­ 4.85; p: 0.016), similar a lo observado en los pacientes con infección de la herida quirúrgica y/u osteomielitis (RR: 2.76; IC- 95 %: 1.60 ­ 4.79; p: 0.001) y en aquellos con diagnóstico de TEP (RR: 2.72; IC ­ 95 %: 1.48 ­ 4.97; p: 0.055). No se determinó asociación estadísticamente significativa entre la presencia de comorbilidades y desarrollo de complicaciones o fallecimiento. CONCLUSIÓN: El desarrollo de al menos una complicación duplica el riesgo de mortalidad y es aún mayor en los pacientes complicados con infección de la herida, osteomielitis y/o TEP; la presencia de dos o más complicaciones determina un riesgo 2 veces mayor de fallecimiento.(AU)

BACKGROUND: The incidence of hip fractures in Ecuador is around 314/100.000 people per year. The aim of this study was to establish the incidence and risk factors associated to morbidity and mortality in patients diagnosed with hip fracture. METHODS: This is a retrospective analytic-cohort research, it studied incidence and associated risks to morbidity and mortality. Patients diagnosed with hip fracture and treated at José Carrasco Arteaga Hospital during 2015 were included. Basic descriptive statistics, chi-square and relative risk (with 95% confidence interval) were used to analyze data. P value under 0.05 was used to determine statistical significance. RESULTS: 81 patients were part of the study. Most common complications were: surgical site infection (13.58 %), pneumonia (12.34 %) and osteosynthesis failure (9.87 %). General mortality reached 32.1 %. Patients with 2 or more complications had near double risk of death (RR: 2.94; 95 % - CI: 1.78 ­ 4.85; p: 0.016) as observed in those with surgical site infections or osteomyelitis (RR: 2.76; 95 % - CI: 1.60 ­ 4.79; p: 0.001) and in patients diagnosed with pulmonary embolism (RR: 2.72; 95 % - CI: 1.48 ­ 4.97; p: 0.055). Statistically significant association was not determined between presence of comorbidities and death or complications. CONCLUSION: Development of at least one complication after hip fracture duplicates death risk and is even higher in those patients with surgical site infections, osteomyelitis and/or pulmonary embolism; presence of two or more complications increased risk of death twice. (AU)

Morbimortalidad en Pacientes con Diagnóstico de Fractura de Cadera Atendidos en el Hospital de Especialidades José Carrasco Arteaga, 2015 / Morbidity and Mortality of Patients Diagnosed with Hip Fracture at José Carrasco Arteaga Specialties Hospital. 2015

INTRODUCCIÓN: La incidencia de fractura de cadera en el Ecuador se estima en 314 casos por 100.000 habitantes al año. El objetivo del presente estudio fue establecer la incidencia y factores de riesgo asociados a morbimortalidad en pacientes con diagnóstico de fractura de cadera. MÉTODO: Estudio retrospectivo y analítico de cohorte que estudió la incidencia y riesgo asociado a morbimortalidad. Se incluyeron todos los pacientes diagnosticados con fractura de cadera que fueron tratados en el Hospital de Especialidades José Carrasco Arteaga durante el año 2015. Para el análisis se utilizó la estadística básica descriptiva, chi-cuadrado y análisis de riesgo relativo con un intervalo de confianza al 95% (p: <0.05) para determinar significancia estadística. RESULTADOS: Se estudiaron 81 pacientes. Las complicaciones más frecuentes fueron: infección del sitio quirúrgico (13.58 %), neumonía (12.34 %) y fallo de osteosíntesis (9.87 %). La mortalidad general fue de 32.1 %. Los pacientes con dos o más complicaciones tuvieron casi dos veces más riesgo de fallecimiento (RR: 2.94; IC ­ 95 %: 1.78 ­ 4.85; p: 0.016), similar a lo observado en los pacientes con infección de la herida quirúrgica y/u osteomielitis (RR: 2.76; IC- 95 %: 1.60 ­ 4.79; p: 0.001) y en aquellos con diagnóstico de TEP (RR: 2.72; IC ­ 95 %: 1.48 ­ 4.97; p: 0.055). No se determinó asociación estadísticamente significativa entre la presencia de comorbilidades y desarrollo de complicaciones o fallecimiento. CONCLUSIÓN: El desarrollo de al menos una complicación duplica el riesgo de mortalidad y es aún mayor en los pacientes complicados con infección de la herida, osteomielitis y/o TEP; la presencia de dos o más complicaciones determina un riesgo 2 veces mayor de fallecimiento.(AU)

BACKGROUND: The incidence of hip fractures in Ecuador is around 314/100.000 people per year. The aim of this study was to establish the incidence and risk factors associated to morbidity and mortality in patients diagnosed with hip fracture. METHODS: This is a retrospective analytic-cohort research, it studied incidence and associated risks to morbidity and mortality. Patients diagnosed with hip fracture and treated at José Carrasco Arteaga Hospital during 2015 were included. Basic descriptive statistics, chi-square and relative risk (with 95% confidence interval) were used to analyze data. P value under 0.05 was used to determine statistical significance. RESULTS: 81 patients were part of the study. Most common complications were: surgical site infection (13.58 %), pneumonia (12.34 %) and osteosynthesis failure (9.87 %). General mortality reached 32.1 %. Patients with 2 or more complications had near double risk of death (RR: 2.94; 95 % - CI: 1.78 ­ 4.85; p: 0.016) as observed in those with surgical site infections or osteomyelitis (RR: 2.76; 95 % - CI: 1.60 ­ 4.79; p: 0.001) and in patients diagnosed with pulmonary embolism (RR: 2.72; 95 % - CI: 1.48 ­ 4.97; p: 0.055). Statistically significant association was not determined between presence of comorbidities and death or complications. CONCLUSION: Development of at least one complication after hip fracture duplicates death risk and is even higher in those patients with surgical site infections, osteomyelitis and/or pulmonary embolism; presence of two or more complications increased risk of death twice. (AU)