Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial).

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.

Inhaled corticosteroid use is associated with lower mortality for subjects with COPD and hospitalised with pneumonia.

Recent studies suggest that use of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) may be associated with a higher incidence of pneumonia. However, it is unclear whether COPD subjects on ICS who develop pneumonia have worse outcomes. Therefore, our aim was to examine the association of prior outpatient ICS therapy with mortality in hospitalised COPD subjects with pneumonia. We included subjects ≥64 yrs of age, hospitalised with pneumonia in US Veterans Affairs hospitals, and assessed the association of ICS exposure with mortality for hospitalised COPD subjects with pneumonia in a covariate-adjusted regression model. We identified 6,353 subjects with a diagnosis of pneumonia and prior COPD, of whom 38% were on ICS. Mortality was 9% at 30 days and 16% at 90 days. In regression analyses, outpatient ICS therapy was associated with lower mortality at both 30 days (OR 0.76, 95% CI 0.70-0.83), and 90 days (OR 0.80, 95% CI 0.75-0.86). Outpatient therapy with ICS was associated with a significantly lower 30- and 90-day mortality in hospitalised COPD patients with pneumonia.

¿Qué se esconde detrás de estas dos figuras? / What is hidden behind these two figures?

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Sedación para adaptación a ventilación mecánica no invasiva en paciente crítico / Sedation for adaptation to non-invasive mechanical ventilation in a critical patient

Presentamos el caso de un paciente con enfermedad pulmonar tipo enfisema con limitación grave del flujo aéreo ingresado por agudización de su enfermedad pulmonar en situación de acidosis respiratoria severa (pH 7,20 PaCO2 98) y un cuadro de agitación asociado. Dada la mala condición fisiológica y el deterioro importante de la función pulmonar (EPOCgrave con FEV1 de 840 mL –30%), insuficiencia respiratoria crónica con oxigenoterapia domiciliaria, disnea grado IIIII y múltiples agudizaciones previas, a pesar de la situación crítica, el paciente no era candidato a intubación orotraqueal y ventilación mecánica e ingreso en UVI por lo que se realizó con éxito ventilación mecánica no invasiva (VNI) modo BIPAP con sedación. La consideración de someter al paciente a una sedación superficial (Ramsay 2-4) se sustentó en la situación de agitación psicomotriz provocada por la acidosis, la cual le impedía una adecuada adaptación a la VNI

We present the case of a patient with emphysema type lung disease with serious limitation of air flow hospitalized due to deterioration of his lung disease in situation of severe respiratory acidosis (pH 7.20 PaCO2 98) and a picture of associated agitation. Given his bad physiological condition and important deterioration of the lung function (serious COPD withFEV1 of 840 mL –30%), chronic respiratory failure with home oxygen therapy, grade II-III dyspnea and multiple previous deteriorations, and in spite of the critical situation, the patient was not a candidate for orotracheal intubation and mechanical ventilation. he was admitted to the ICA so non-invasive mechanical ventilation (NIV) mode BIPAP with sedationwas done. The consideration of subjecting the patient to superficial sedation (Ramsay 2-4) was supported in the situationof psychomotor agitation provoked by the acidosis. This prevented adequate adaptation to the NIV

Otras formas de broncodilatación / No disponible

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