RESUMEN
Ventilation in a prone position (PP) for 12 to 16 h per day improves survival in ARDS. However, the optimal duration of the intervention is unknown. We performed a prospective observational study to compare the efficacy and safety of a prolonged PP protocol with conventional prone ventilation in COVID-19-associated ARDS. Prone position was undertaken if P/F < 150 with FiO2 > 0.6 and PEEP > 10 cm H2O. Oxygenation parameters and respiratory mechanics were recorded before the first PP cycle, at the end of the PP cycle and 4 h after supination. We included 63 consecutive intubated patients with a mean age of 63.5 years. Of them, 37 (58.7%) underwent prolonged prone position (PPP group) and 26 (41.3%) standard prone position (SPP group). The median cycle duration for the SPP group was 20 h and for the PPP group 46 h (p < 0.001). No significant differences in oxygenation, respiratory mechanics, number of PP cycles and rate of complications were observed between groups. The 28-day survival was 78.4% in the PPP group versus 65.4% in the SPP group (p = 0.253). Extending the duration of PP was as safe and efficacious as conventional PP, but did not confer any survival benefit in a cohort of patients with severe ARDS due to COVID-19.
RESUMEN
INTRODUCTION: Lung cancer is the most common cancer in the world, both in terms of new cases and deaths. Almost a fifth of all cancer deaths worldwide are due to lung cancers. Our aim was to evaluate the utility of endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) for lymph node staging in patients with lung cancer. METHODS: We performed a retrospective study on a total of 427 patients who underwent EBUS-TBNA sampling from January 2020 to December 2020 and a total of 610 lymph nodes were sampled. There were 322 men (mean age: 66.3 and range: 20-87) and 105 women (mean age: 65.9 and range: 18-81). RESULTS: Cytological diagnosis revealed that 55 patients had adenocarcinoma, 28 squamous cell carcinoma, 43 neuroendocrine tumours, 34 non-small cell carcinoma not otherwise specified, 21 metastasis from extra-thoracic malignancy, 7 atypical cells suspicious for malignancy, and 239 patients had normal or reactive lymph nodes or non-neoplastic diagnosis. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 91%, 88.3%, 100%, 100% and 89.2%, respectively. CONCLUSION: EBUS-TBNA is a safe technique with high accuracy, sensitivity, specificity, PPV, and NPV. It is an excellent option for the diagnostic approach of patients with lymphadenopathy or intra-thoracic lesions as well as for the staging of malignancies.