Importancia del anión GAP ante la falta de información clínica: descripción de un caso clínico de intoxicación oral grave por metanol / Importance of GAP anion in the absence of clinical information: Description of one clinical case of severe oral methanol poisoning

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Nasal flaring as a clinical sign of respiratory acidosis in patients with dyspnea.

OBJECTIVE: To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. METHODS: Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models. RESULTS: The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9-7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13-5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78-14.41) were maintained as factors independently associated with acidosis. CONCLUSIONS: Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia.

Aleteo nasal como factor pronóstico de mortalidad en el paciente con disnea grave / Nasal flaring as a predictor of mortality in patients with severe dyspnea

Objetivos: Determinar si la presencia de aleteo nasal es un factor de gravedad clínica y pronóstico de mortalidad hospitalaria en el paciente que consulta en urgencias por disnea. Método: Estudio prospectivo observacional un céntrico. Se incluyeron pacientes mayores de 15 años, que demandaron atención urgente por disnea, catalogados como niveles II y III por el Modelo Andorrano de Triaje (MAT). Se evaluó la presencia de aleteo nasal por dos observadores. Se recogieron variables demográficas, clínicas, signos de dificultad respiratoria, signos vitales, gasometría arterial y evolución clínica (ingreso hospitalario y mortalidad). Se realizaron análisis bivariantes y multivariantes con modelos de regresión logística. Resultados: Se incluyeron 246 pacientes, de edad media ± DE 77 (13) años (DE: 13,2) y un 52% de mujeres. Un19,5% presentaron aleteo nasal. Los pacientes con aleteo nasal tuvieron mayor gravedad en el triaje, más taquipnea, peor oxigenación, más acidosis y más hipercapnia. En el análisis bivariante los factores pronósticos de mortalidad hospitalaria fueron la edad (OR 1,05; IC95%: 1,01-1,10), la atención prehospitalaria por el servicio emergencias médicas (OR 3,97; IC95%: 1,39-11,39), el nivel de triaje II (OR 4,19; IC95%: 1,63-10,78), la presencia de signos de dificultad respiratoria como el aleteo nasal (OR 3,79; IC 95%: 1,65-8,69), la presencia de acidosis (OR 7,09; IC95%: 2,97-16,94) y la hipercapnia (OR 2,67; IC95%: 1,11-6,45). En el análisis multivariante, la edad, el nivel de triaje y el aleteonasal se mantuvieron como factores pronósticos independientes de mortalidad (AU)

Objective: To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea. Methods: Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencies according to the Andorran Medical Triage system. Two observers evaluated the presence of nasal flaring. We recorded demographic and clinical variables, including respiratory effort, vital signs, arterial blood gases, and clinical course (hospital admission and mortality). Bivariable analysis was performed and multivariable logistic regression models were constructed. Results: We enrolled 246 patients with a mean (SD) age of 77 (13) years; 52% were female. Nasal flaring was present in 19.5%. Patients with nasal flaring had triage levels indicating greater severity and they had more severe tachypnea, worse oxygenation, and greater acidosis and hypercapnia. Bivariable analysis detected that the following variables were associated with mortality: age (odds ratio [OR], 1.05; 95% CI, 1.01–1.10), prehospital care from the emergency medical service (OR, 3.97; 95% CI, 1.39–11.39), triage level II (OR, 4.19; 95% CI, 1.63–10.78), signs of respiratory effort such as nasal flaring (OR, 3.79; 95% CI, 1.65–8.69), presence of acidosis (OR, 7.09; 95% CI, 2.97–16.94), and hypercapnia (OR, 2.67; 95% CI, 1,11–6,45). The factors that remained independent predictors of mortality in the multivariable analysis were age, severity (triage level), and nasal flaring. Conclusions: In patients requiring emergency care for dyspnea, nasal flaring is a clinical sign of severity and a predictor of mortality (AU)

[Nasal flaring as a predictor of mortality in patients with severe dyspnea]. / Aleteo nasal como factor pronóstico de mortalidad en el paciente con disnea grave.

OBJECTIVES: To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea. MATERIAL AND METHODS: Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencies according to the Andorran Medical Triage system. Two observers evaluated the presence of nasal flaring. We recorded demographic and clinical variables, including respiratory effort, vital signs, arterial blood gases, and clinical course (hospital admission and mortality). Bivariable analysis was performed and multivariable logistic regression models were constructed. RESULTS: We enrolled 246 patients with a mean (SD) age of 77 (13) years; 52% were female. Nasal flaring was present in 19.5%. Patients with nasal flaring had triage levels indicating greater severity and they had more severe tachypnea, worse oxygenation, and greater acidosis and hypercapnia. Bivariable analysis detected that the following variables were associated with mortality: age (odds ratio [OR], 1.05; 95% CI, 1.01-1.10), prehospital care from the emergency medical service (OR, 3.97; 95% CI, 1.39-11.39), triage level II (OR, 4.19; 95% CI, 1.63-10.78), signs of respiratory effort such as nasal flaring (OR, 3.79; 95% CI, 1.65-8.69), presence of acidosis (OR, 7.09; 95% CI, 2.97-16.94), and hypercapnia (OR, 2.67; 95% CI, 1,11-6,45). The factors that remained independent predictors of mortality in the multivariable analysis were age, severity (triage level), and nasal flaring. CONCLUSION: In patients requiring emergency care for dyspnea, nasal flaring is a clinical sign of severity and a predictor of mortality.

OBJETIVO: Determinar si la presencia de aleteo nasal es un factor de gravedad clínica y pronóstico de mortalidad hospitalaria en el paciente que consulta en urgencias por disnea. METODO: Estudio prospectivo observacional unicéntrico. Se incluyeron pacientes mayores de 15 años, que demandaron atención urgente por disnea, catalogados como niveles II y III por el Modelo Andorrano de Triaje (MAT). Se evaluó la presencia de aleteo nasal por dos observadores. Se recogieron variables demográficas, clínicas, signos de dificultad respiratoria, signos vitales, gasometría arterial y evolución clínica (ingreso hospitalario y mortalidad). Se realizaron análisis bivariantes y multivariantes con modelos de regresión logística. RESULTADOS: Se incluyeron 246 pacientes, de edad media ± DE 77 (13) años (DE: 13,2) y un 52% de mujeres. Un 19,5% presentaron aleteo nasal. Los pacientes con aleteo nasal tuvieron mayor gravedad en el triaje, más taquipnea, peor oxigenación, más acidosis y más hipercapnia. En el análisis bivariante los factores pronósticos de mortalidad hospitalaria fueron la edad (OR 1,05; IC95%: 1,01-1,10), la atención prehospitalaria por el servicio emergencias médicas (OR 3,97; IC95%: 1,39-11,39), el nivel de triaje II (OR 4,19; IC95%: 1,63-10,78), la presencia de signos de dificultad respiratoria como el aleteo nasal (OR 3,79; IC 95%: 1,65-8,69), la presencia de acidosis (OR 7,09; IC95%: 2,97- 16,94) y la hipercapnia (OR 2,67; IC95%: 1,11-6,45). En el análisis multivariante, la edad, el nivel de triaje y el aleteo nasal se mantuvieron como factores pronósticos independientes de mortalidad. CONCLUSIONES: El aleteo nasal es un signo clínico de gravedad y predictor de mortalidad en los pacientes que demandan atención urgente por disnea.