Characteristics and Prognosis of Patients Who Receive Noninvasive Ventilation and Present Limitation of Life Support Treatment: The LLST-NIVCat Multicenter Cohort Study.

BACKGROUND: Patients who receive noninvasive ventilation (NIV) in the emergency department (ED) sometimes have a limitation of life support treatment (LLST). The characteristics and prognosis in these patients may be worse, however, few studies have been carried out in this respect. OBJECTIVE: Analyze the differences between patients receiving NIV in the ED with LLST (NIV-LLST) or without LLST (NIV-noLLST) and their impact on in-hospital mortality, as well as investigate in-hospital mortality in the NIV-LLST group. METHOD: We performed a secondary analysis of data from the NIVCat registry. This was a prospective, multicenter, analytical cohort study with consecutive inclusion of patients receiving NIV from February to March 2015 in 11 hospital EDs in Spain. Data on the baseline characteristics, the acute episode, and final patient destination were collected. The dependent variable was all-cause in-hospital mortality. RESULTS: We analyzed 152 cases receiving NIV, 66 (43.4%) of whom had NIV-LLTS. Age ≥ 75 years was associated with NIV-LLST. In-hospital mortality was higher in the NIV-LLST group, with an adjusted hazard ratio of 2.50 (95% confidence interval [CI] 1.03-6.06). Patients with NIV-LLST presenting an exacerbation of chronic obstructive pulmonary disease (COPD) presented the lowest mortality, with an odds ratio of 0.27 (95% confidence interval 0.08-0.93), compared with the remaining patients. CONCLUSION: In our cohort of patients receiving NIV in the ED, the presence of LLST is frequent and is associated with high hospital mortality. The NIV-LLST patients with a COPD exacerbation have a better prognosis than NIV-LLST patients with other diseases.

Effect of the administration of a probiotic with a combination of Lactobacillus and Bifidobacterium strains on antibiotic-associated diarrhea / Efecto de la administración de un probiótico con lactobacilos y bifidobacterias en la diarrea asociada a antibióticos

OBJECTIVES: The aim of this study is to analyze the effect, safety and tolerability of a specific probiotic combination of Lactobacillus and Bifidobacterium strains (Pearls IC©) on antibiotic associated diarrhea due to amoxicillin-clavulanic acid treatment. PATIENTS AND METHODS: Pilot, unicentric, randomized, double-blind, parallel group, placebo-controlled study (probiotic vs. placebo for 30 days). Target population: Adult patients, both sexes treated with amoxicillin-clavulanic acid (850mg / 125mg every 8h /orally) for 7 days who attended the Emergency Department (Dexeus Hospital, Barcelona) between January and April of 2018 with prior signed informed consent with a follow up at 30 days. Variables: The differences between day 0 and day 30 of the number of daily stools and duration of diarrhea were evaluated; Stool consistency according to Bristol Stool Form, Quality of intestinal life. Subjective evaluation and evaluation of adverse effects of the product through a specifically designed questionnaire. RESULTS: Thirty-six subjects were included (18 per group) 25 females and 11 males, average age of 38.5 years (range 19-65 years). Pearls IC© delayed between 4 and 5 days the appearance of the diarrheic episode vs. placebo (p <0.001). The results of the quality of life assessment showed an improvement at the end of the 30 days period but without difference vs placebo. The results of the subjective assessment were in favor of the probiotic with higher rate of like responses than placebo. CONCLUSIONS: Pearls IC© demonstrated its beneficial effect on antibiotic associated diarrhea by delaying the onset of diarrhea and showed a tendency to decrease the number of daily stools vs. placebo

INTRODUCCIÓN: El objetivo es analizar el efecto y la seguridad de una combinación probiótica específica de lactobacilos y bifidobacterias (Pearls IC©) en la diarrea asociada a antibióticos debida al tratamiento con amoxicilina-ácido clavulánico. PACIENTES Y MÉTODOS: Estudio piloto, unicéntrico, aleatorizado, doble ciego, paralelo, controlado con placebo. Población objetivo: pacientes adultos, ambos sexos tratados con amoxicilina-ácido clavulánico (850mg / 125mg cada 8h / oral) durante 7 días que asistieron a un Servicio de Urgencias entre enero y abril de 2018 con consentimiento informado previo firmado con un seguimiento a los 30 días. Variables: se evaluaron las diferencias entre el día 0 y el día 30 del número de deposiciones diarias y la duración de la diarrea; Consistencia de las heces según la forma de heces de Bristol, calidad de vida intestinal. Evaluación subjetiva y evaluación de los efectos adversos del producto a través de un cuestionario específicamente diseñado. RESULTADOS: Se incluyeron 36 sujetos (18 por grupo), 25 mujeres y 11 hombres, con una edad promedio de 38,5 años (rango 19-65 años). Pearls IC© retrasó entre 4 y 5 días la aparición del episodio diarreico versus placebo (p < 0,001). Los resultados de la evaluación de la calidad de vida mostraron una mejoría al final del período de estudio, pero sin diferencias frente a placebo. Los resultados de la evaluación subjetiva fueron a favor del probiótico con una tasa más alta de respuestas similares que el placebo. CONCLUSIONES: Pearls IC© demostró su efecto beneficioso sobre la diarrea asociada a antibióticos al retrasar el inicio de la diarrea y mostró una tendencia a disminuir el número de deposiciones diarias versus placebo

[Noninvasive mechanical ventilation in emergency services in Catalonia: the VNICat registry cohort study]. / Estudio de cohortes de pacientes tratados con ventilación no invasiva en servicios de urgencias prehospitalarios y hospitalarios de Cataluña: registro VNICat.

OBJECTIVES: To study how noninvasive ventilation (NIV) is used in prehospital emergency services and hospital emergency departments. To explore associations between NIV use and hospital mortality. MATERIAL AND METHODS: Prospective analysis of a consecutive multicenter cohort of patients who were treated with NIV between February and March 2015. The study was undertaken in emergency medical services in Catalonia and 8 Catalan hospital emergency departments. We collected information during the acute episode and on discharge, as well as data describing the patients' condition when stable. The dependent variable was all-cause hospital mortality. RESULTS: We studied 184 acute episodes requiring NIV, in the prehospital setting in 25 cases (13.6%) and in the hospital in 159 (86.4%). The most common scenario was acute heart failure (AHF) (38.0%). The second most common was chronic obstructive pulmonary disease (COPD) (34.2%). In most cases, NIV was discontinued in the emergency department. Mortality was 7.5% during prehospital care and 21.4% in the hospital. Hospital mortality was associated with limiting the use of life support. We detected no significant differences in mortality between the groups of patients with AHF vs COPD. CONCLUSION: The use of NIV in prehospital and hospital emergency care follows current evidence-based recommendations and is required more often for AHF than for exacerbated COPD. Hospital mortality is high in this context and is associated with frequent limiting of life support.

OBJETIVO: Conocer las características de la ventilación no invasiva (VNI) en los servicios de urgencias prehospitalarios y hospitalarios. Comparar los resultados obtenidos en función de la mortalidad hospitalaria. METODO: Estudio de cohortes multicéntrico, analítico, prospectivo con inclusión consecutiva de pacientes en los que se realizó VNI durante febrero y marzo de 2015 en el ámbito prehospitalario por el Sistema d'Emergències Mèdiques (SEM) y en 8 servicios de urgencias (SU) hospitalarios de Cataluña. Se recogieron las características basales, del episodio agudo y de destino, y la variable dependiente fue la mortalidad hospitalaria por todas las causas. RESULTADOS: Se recogieron 184 episodios de VNI, 25 episodios (13,6%) prehospitalarios y 159 (86,4%) hospitalarios. El escenario más frecuente para su uso fue la insuficiencia cardiaca aguda (ICA) (38,0%) seguido de la agudización de la enfermedad pulmonar obstructiva crónica (EPOC) (34,2%). En la mayoría de casos la VNI se retira en los SU. La mortalidad fue del 7,5% y del 21,4% en urgencias prehospitalarias y hospitalarias, respectivamente. La mortalidad hospitalaria se relacionó con más presencia de limitación del tratamiento de soporte vital (LTSV). No hubo diferencias de mortalidad entre los diferentes escenarios clínicos. CONCLUSIONES: La VNI en los SU prehospitalarios y hospitalarios sigue las recomendaciones de la evidencia científica actual y se realiza principalmente en la ICA y en la agudización de la EPOC. La mortalidad hospitalaria es elevada y se relaciona con la LTSV, que es muy frecuente.

Estudio de cohortes de pacientes tratados con ventilación no invasiva en servicios de urgencias prehospitalarios y hospitalarios de Cataluña: registro VNICat / Non invasive mechanical ventilation in emergency services in Catalonia: the VNICat registry cohort study

Objetivo: Conocer las características de la ventilación no invasiva (VNI) en los servicios de urgencias prehospitalarios y hospitalarios. Comparar los resultados obtenidos en función de la mortalidad hospitalaria. Método: Estudio de cohortes multicéntrico, analítico, prospectivo con inclusión consecutiva de pacientes en los que se realizó VNI durante febrero y marzo de 2015 en el ámbito prehospitalario por el Sistema d’Emergències Mèdiques (SEM) y en 8 servicios de urgencias (SU) hospitalarios de Cataluña. Se recogieron las características basales, del episodio agudo y de destino, y la variable dependiente fue la mortalidad hospitalaria por todas las causas. Resultados: Se recogieron 184 episodios de VNI, 25 episodios (13,6%) prehospitalarios y 159 (86,4%) hospitalarios. El escenario más frecuente para su uso fue la insuficiencia cardiaca aguda (ICA) (38,0%) seguido de la agudización de la enfermedad pulmonar obstructiva crónica (EPOC) (34,2%). En la mayoría de casos la VNI se retira en los SU. La mortalidad fue del 7,5% y del 21,4% en urgencias prehospitalarias y hospitalarias, respectivamente. La mortalidad hospitalaria se relacionó con más presencia de limitación del tratamiento de soporte vital (LTSV). No hubo diferencias de mortalidad entre los diferentes escenarios clínicos. Conclusiones: La VNI en los SU prehospitalarios y hospitalarios sigue las recomendaciones de la evidencia científica actual y se realiza principalmente en la ICA y en la agudización de la EPOC. La mortalidad hospitalaria es elevada y se relaciona con la LTSV, que es muy frecuente (AU)

Objectives: To study how noninvasive ventilation (NIV) is used in prehospital emergency services and hospital emergency departments. To explore associations between NIV use and hospital mortality. Methods: Prospective analysis of a consecutive multicenter cohort of patients who were treated with NIV between February and March 2015. The study was undertaken in emergency medical services in Catalonia and 8 Catalan hospital emergency departments. We collected information during the acute episode and on discharge, as well as data describing the patients' condition when stable. The dependent variable was all-cause hospital mortality. Results: We studied 184 acute episodes requiring NIV, in the prehospital setting in 25 cases (13.6%) and in the hospital in 159 (86.4%). The most common scenario was acute heart failure (AHF) (38.0%). The second most common was chronic obstructive pulmonary disease (COPD) (34.2%). In most cases, NIV was discontinued in the emergency department. Mortality was 7.5% during prehospital care and 21.4% in the hospital. Hospital mortality was associated with limiting the use of life support. We detected no significant differences in mortality between the groups of patients with AHF vs COPD. Conclusions: The use of NIV in prehospital and hospital emergency care follows current evidence-based recommendations and is required more often for AHF than for exacerbated COPD. Hospital mortality is high in this context and is associated with frequent limiting of life support (AU)

Stroke-related headache: a clinical study in lacunar infarction.

OBJECTIVE: To describe the characteristics of headache related to lacunar stroke based on data collected from a prospective hospital-based stroke registry over a 12-year period. Demographics, clinical variables, and prognostic features of lacunar stroke in patients with and without headache are compared. BACKGROUND: Stroke-related headache has been largely investigated, but there is little clinical data on headache in individualized stroke subtypes. METHODS: The cohort of 484 patients with lacunar infarction was selected. Forty-five (9.3%) presented headache within a 72-hour interval of stroke onset. Predictors of lacunar infarction with headache were assessed by logistic regression analysis. RESULTS: The intensity of headache was mild in severity and poorly localized (diffuse or bilateral headache). Tension-type headache was present in 36 patients (80%) and 9 patients (20%) presented nausea or vomiting while experiencing mild pulsating pain. The frequency of headache was 17% in patients with atypical lacunar syndrome, 12% in dysarthria-clumsy hand, 11.5% in pure sensory stroke, 9.4% in sensorimotor stroke, and 7.1% in pure motor hemiparesis. When patients with lacunar infarction with and without headache were compared, female sex, diabetes mellitus, nausea and vomiting, and mesencephalic topography were significantly more frequent and dysarthria and frequency of symptom free at discharge were less frequent in the headache group. In the multivariate analysis, mesencephalic topography (odds ratio [OR] 16.62), nausea and vomiting (OR 13.27), sex female (OR 2.29), diabetes mellitus (OR 1.96), and age (OR 0.95) were predictors of lacunar infarction with headache. CONCLUSIONS: Headache at the onset of a lacunar infarction is uncommon. Mesencephalic topography, nausea and vomiting, female sex, diabetes, and age were independent variables significantly associated with lacunar infarction with headache. These findings contribute to knowledge of stroke-related headache in patients with lacunes.