[All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic]. / Todos los caminos llevan a Roma: resultados de las terapias respiratorias no invasivas aplicadas en un centro terciario sin Unidad de Cuidados Intermedios durante la pandemia de COVID-19.

Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Embolia gaseosa arterial: una rara complicación de la biopsia con aguja gruesa en el diagnóstico del nódulo pulmonar solitario / Arterial Gas Embolism: A Rare Complication of Core Needle Biopsy in the Diagnosis of Solitary Pulmonary Nodule

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Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain.

BACKGROUND: Bronchial thermoplasty (BT) is a minimally invasive procedure consisting of application of thermal energy into the airways to produce ablation of the hypertrophic smooth muscle. It was approved for use in moderate-severe asthma in Spain in 2010. OBJECTIVES: The aims of the present study are to analyze the effectiveness and the safety of BT in clinical practice in our center. METHODS: Participants had a confirmed diagnosis of severe asthma and poor control without therapeutic alternative. Effectiveness was measured by comparing exacerbations, admissions rates, asthma control, and medication 1 year prior and 1 year after BT was completed. All complications appearing during the procedure and in the first year were recorded. RESULTS: Patients had a mean age of 51 (SD 8) years and were predominantly female (17/23). The average number of activations per patient was 147 (16). The number of severe exacerbations was reduced by 75% (p < 0.001). A 38% reduction in admissions per year was also observed (p = 0.03). The Asthma Control Test improved by 7.1 (3.7) points (p = 0.018). Before BT, the dose of inhaled corticosteroids was 1,621 (1,015) µg of budesonide-equivalent and the dose of oral corticosteroids was 15 (13) mg of prednisone-equivalent. There was a reduction in 430 (731) µg of budesonide-equivalent (p = 0.02) and 4 (11) mg of prednisone (p = 0.094). No changes in lung function were observed. Complications were related mostly to exacerbation of asthma in the days following the procedure. CONCLUSIONS: BT is effective and safe for severe uncontrolled bronchial asthma in real clinical practice.

Síndrome de apnea-hipopnea del sueño / Sleep apnoea-hypopnoea syndrome

El síndrome de apnea-hipopnea del sueño es un trastorno médico infradiagnosticado con una importancia creciente. Se asocia a enfermedades cardiovasculares, cerebrovasculares, hipertensión arterial, resistencia a insulina y accidentes de tráfico, con el consiguiente deterioro de calidad de vida y aumento de mortalidad. Los síntomas más característicos son ronquido, apneas presenciadas y excesiva somnolencia diurna. La polisomnografía es la prueba de referencia para el diagnóstico, aunque en los pacientes con una alta probabilidad pretest se debería optar por la poligrafía respiratoria, una prueba más accesible y menos costosa. Aparte de la realización de medidas higiénico-dietéticas, el tratamiento de elección es la presión positiva continua de la vía aérea. Algunas técnicas quirúrgicas pueden tener utilidad en el tratamiento del síndrome de apnea-hipopnea del sueño. En pacientes que no toleran la presión positiva continua de la vía aérea, no son candidatos a cirugía o tienen un riesgo quirúrgico elevado, se podrían utilizar dispositivos intraorales (AU)

Sleep apnea-hypopnea syndrome is an underdiagnosed medical condition which is gainingin importance. It is associated with cardiovascular disease, stroke, hypertension, insulin resistance and traffic accidents, resulting in deterioration of quality of life and increased mortality in these patients. The most characteristic symptoms of the disease are snoring, documented apnoeas and excessive daytime sleepiness. Polysomnography is the gold standard for diagnosis, but in patients with high pre-test probability, we should opt for respiratory polygraphy, a more accessible and less expensive test. Besides making lifestyle changes, the treatment of choice is continuous positive airway pressure. Some surgical techniques may be useful in the treatment of sleep apnoea-hypopnoea syndrome. In patients who cannot tolerate continuous positive airway pressure, are not candidates for surgery or have a high surgical risk intraoral devices might be used (AU)

[Sleep apnoea-hypopnoea syndrome]. / Síndrome de apnea-hipopnea del sueño.

Sleep apnea-hypopnea syndrome is an underdiagnosed medical condition which is gainingin importance. It is associated with cardiovascular disease, stroke, hypertension, insulin resistance and traffic accidents, resulting in deterioration of quality of life and increased mortality in these patients. The most characteristic symptoms of the disease are snoring, documented apnoeas and excessive daytime sleepiness. Polysomnography is the gold standard for diagnosis, but in patients with high pre-test probability, we should opt for respiratory polygraphy, a more accessible and less expensive test. Besides making lifestyle changes, the treatment of choice is continuous positive airway pressure. Some surgical techniques may be useful in the treatment of sleep apnoea-hypopnoea syndrome. In patients who cannot tolerate continuous positive airway pressure, are not candidates for surgery or have a high surgical risk intraoral devices might be used.