Eradication of Pseudomonas aeruginosa with inhaled colistin in adults with non-cystic fibrosis bronchiectasis.

The persistent isolation of Pseudomonas aeruginosa in the airways of non-cystic fibrosis bronchiectasis (NCFB) patients is associated with a worsening of the symptoms, increase of exacerbations, poor quality of life and functional impairment. The objective of this study was the analysis of the eradication rate of P. aeruginosa in the sputum of patients with NCFB treated with inhaled colistin and the effects of the treatment in the exacerbations. This was a prospective, cohort, study of 67 NCFB patients treated with inhaled colistin at the Hospital of A Coruña (Spain). We recorded dyspnoea, exacerbations, lung function and sputum cultures of P. aeruginosa in the patients. The mean age of the patients was 67.25 ± 14.6 years (59.7% male). The percentages of eradication of P. aeruginosa in sputum at 3, 6, 9 and 12 months were 61.2%, 50.7%, 43.3% and 40.3%, respectively. We observed a significant decrease in exacerbations after 1 year of colistin treatment (1.98 ± 3.62) versus the previous year (3.40 ± 4.21, p < 0.001). We conclude that treatment with inhaled colistin in patients with NCFB and P. aeruginosa in sputum can achieve high rates of eradication even in patients with several previous positive cultures, as well as a significant decrease of exacerbations and hospital admissions.

Esclerosis lateral amiotrófica: impacto del seguimiento neumológico y ventilación mecánica en la supervivencia. Experiencia en 114 casos / Amyotrophic Lateral Sclerosis: Impact of Pulmonary Follow-Up and Mechanical Ventilation on Survival. A Study of 114 Cases

Objetivo: Conocer el impacto en la supervivencia del manejo y tratamiento ventilatorio de enfermos con esclerosis lateral amiotrófica (ELA). Método: Análisis retrospectivo de 114 pacientes con ingreso consecutivo en un hospital general, evaluandodatos demográficos, tipo de presentación, manejo clínico, tratamiento con ventilación mecánica y supervivencia. Estadística: descriptiva y análisis de Kaplan-Meier. Resultados: Sesenta y cuatro pacientes tenían afectación bulbar inicial. La supervivencia media global tras el diagnóstico fue 28,0 meses (IC 95%, 21,1-34,8). Setenta pacientes fueron derivados al neumólogo (61,4%) y 43 recibieron ventilación no invasiva (VMNI) a los 12,7 meses (mediana) del diagnóstico. Se mantuvieron con VMNI sin posterior ventilación invasiva 37 pacientes, cuya supervivencia media fue de 23,3 meses (IC 95%, 16,7-28,8), superior en los no bulbares, aunque en rango no significativo. En 26 en los que la VMNI se indicó de manera programada la supervivencia fue mayor que en 11 en que se indicó sin evaluación neumológica previa (considerando tras el diagnóstico, p < 0,012, y en función del comienzo de la ventilación, p < 0,004). Se trataron en modalidad invasiva 7 pacientes cuya supervivencia fue de 72 meses (IC 95%, 14,36-129,6), mediana de 49,6 ± 17,5 (IC 95%, 15,3-83,8), y pese a las dificultades de laatención en domicilio, la aceptación y la tolerancia fueron aceptables. Conclusiones: La ventilación mecánica prolonga la supervivencia de la ELA. La evaluación neumológica programada tiene un impacto favorable en la supervivencia de los pacientes con ELA y constituye un elemento esencial en el manejo multidisciplinario de esta enfermedad

Objective: To study the impact of ventilatory management and treatment on the survival of patients with amyotrophic lateral sclerosis (ALS). Method: Retrospective analysis of 114 consecutive patients admitted to a general hospital, evaluating demographic data, type of presentation, clinical management, treatment with mechanical ventilation and survival. Statistics: descriptive and Kaplan-Meier estimator. Results: Sixty four patients presented initial bulbar involvement. Overall mean survival after diagnosis was 28.0 months (95% CI, 21.1-34.8). Seventy patients were referred to the pulmonary specialist (61.4%) and 43 received non-invasive ventilation (NIV) at 12.7 months (median) after diagnosis. Thirty seven patients continued to receive NIV with no subsequent invasive ventilation. The mean survival of these patients was 23.3 months (95% CI, 16.7-28.8), higher in those without bulbar involvement, although below the range of significance. Survival in the 26 patients receiving programmed NIV was higher than in the 11 patients in whom this was indicated without prior pulmonary assessment (considered following diagnosis, P < .012, and in accordance with the start of ventilation, P < .004). A total of 7 patients were treated invasively; mean survival in this group was 72 months (95% CI, 14.36-129.6), median 49.6 ± 17.5 (95% CI, 15.3-83.8), and despite the difficulties involved in home care, acceptance and tolerance was acceptable. Conclusions: Long-term mechanical ventilation prolongs survival in ALS. Programmed pulmonary assessment has a positive impact on survival of ALS patients and is key to the multidisciplinary management of this disease

Amyotrophic lateral sclerosis: impact of pulmonary follow-up and mechanical ventilation on survival. A study of 114 cases.

OBJECTIVE: To study the impact of ventilatory management and treatment on the survival of patients with amyotrophic lateral sclerosis (ALS). METHOD: Retrospective analysis of 114 consecutive patients admitted to a general hospital, evaluating demographic data, type of presentation, clinical management, treatment with mechanical ventilation and survival. STATISTICS: descriptive and Kaplan-Meier estimator. RESULTS: Sixty four patients presented initial bulbar involvement. Overall mean survival after diagnosis was 28.0 months (95%CI, 21.1-34.8). Seventy patients were referred to the pulmonary specialist (61.4%) and 43 received non-invasive ventilation (NIV) at 12.7 months (median) after diagnosis. Thirty seven patients continued to receive NIV with no subsequent invasive ventilation. The mean survival of these patients was 23.3 months (95%CI, 16.7-28.8), higher in those without bulbar involvement, although below the range of significance. Survival in the 26 patients receiving programmed NIV was higher than in the 11 patients in whom this was indicated without prior pulmonary assessment (considered following diagnosis, P<.012, and in accordance with the start of ventilation, P<.004). A total of 7 patients were treated invasively; mean survival in this group was 72 months (95%CI, 14.36-129.6), median 49.6±17.5 (95%CI, 15.3-83.8), and despite the difficulties involved in home care, acceptance and tolerance was acceptable. CONCLUSIONS: Long-term mechanical ventilation prolongs survival in ALS. Programmed pulmonary assessment has a positive impact on survival of ALS patients and is key to the multidisciplinary management of this disease.