[Evaluation of a home hospitalization program in patients with exacerbations of chronic obstructive pulmonary disease]. / Evaluación de un programa de hospitalización domiciliaria en pacientes con EPOC agudizada.

OBJECTIVE: We carried out a randomized controlled trial to evaluate the efficacy of a home hospitalization (HH) program for patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: Patients who were clinically stable and had stable arterial blood gases were randomized to the conventional hospitalization group or the HH group. RESULTS: Of the 88 patients evaluated, 40 (20 in each group) were enrolled. No differences were observed in baseline characteristics, in clinical recovery, or arterial blood gases between the 2 groups at discharge. At 1-month follow up there were no differences in mortality or in the number of readmissions. The mean length of hospitalization in patients with HH was 9.2 days (4 days in hospital and 5 days at home), compared to 12.2 days in patients with conventional hospitalization. CONCLUSIONS: Our results show that a hospital-supervised HH program including the participation of pneumologists and nursing staff allows for the recovery of patients hospitalized for exacerbation of COPD who have stable symptoms and arterial blood gases with no increase in the rate of readmission, relapse, or therapeutic failure.

Evaluación de un programa de hospitalización domiciliaria en pacientes con EPOC agudizada / Evaluation of a home hospitalization program in patients with exacerbations of chronic obstructive pulmonary disease

OBJETIVO: Se ha realizado un estudio prospectivo, controlado y aleatorizado en grupos paralelos con el fin de evaluar la eficacia de un programa de hospitalización domiciliaria (HD) en pacientes ingresados en el hospital por agudización de la enfermedad pulmonar obstructiva crónica (EPOC). PACIENTES Y MÉTODOS: Los pacientes que cumplían criterios de estabilidad clínica y gasométrica al tercer día se aleatorizaron al grupo de hospitalización convencional o al grupo HD. RESULTADOS: De los 88 pacientes valorados se incluyó a 40 (20 en cada grupo). No se apreciaron diferencias en las características basales, en la recuperación clínica ni en la gasometría al alta entre ambos grupos. Al mes de seguimiento no hubo diferencias en la mortalidad ni en el número de readmisiones. La estancia media de los pacientes con HD fue de 9,2 días (4 días en el hospital y 5 días en su domicilio), frente a los 12,2 días que permanecieron los pacientes en el hospital. CONCLUSIONES: Nuestros resultados demuestran que un programa de HD controlado desde el hospital, con participación de neumólogos y personal de enfermería, en enfermos ingresados con exacerbación de la EPOC que cumplen unos requisitos de estabilidad clínica y gasométrica, permite la recuperación del paciente sin un aumento en la tasa de reingresos, recaídas o fracasos terapéuticos

OBJECTIVE: We carried out a randomized controlled trial to evaluate the efficacy of a home hospitalization (HH) program for patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: Patients who were clinically stable and had stable arterial blood gases were randomized to the conventional hospitalization group or the HH group. RESULTS: Of the 88 patients evaluated, 40 (20 in each group) were enrolled. No differences were observed in baseline characteristics, in clinical recovery, or arterial blood gases between the 2 groups at discharge. At 1-month follow up there were no differences in mortality or in the number of readmissions. The mean length of hospitalization in patients with HH was 9.2 days (4 days in hospital and 5 days at home), compared to 12.2 days in patients with conventional hospitalization. CONCLUSIONS: Our results show that a hospital-supervised HH program including the participation of pneumologists and nursing staff allows for the recovery of patients hospitalized for exacerbation of COPD who have stable symptoms and arterial blood gases with no increase in the rate of readmission, relapse, or therapeutic failure

Noninvasive mechanical ventilation and corrective surgery for treatment of a child with severe kyphoscoliosis.

We report on an 11-year-old boy with severe kyphoscoliosis and respiratory failure. Noninvasive mechanical ventilation by nasal mask and hospitalization resulted in improved pulmonary function, thus facilitating corrective surgery for kyphoscoliosis. Following surgery, the patient remained on mechanical ventilation at home. Clinical and pulmonary function stabilized after discharge, as noted on a 1-month follow-up visit.

[Airway obstruction caused by cervicofacial tuberous hemangioma in treatment with non-invasive mechanical ventilation]. / Obstrucción de la vía aérea por hemangioma tuberoso cérvico-facial en tratamiento con ventilación mecánica no invasiva.

Tuberose haemangioma is an uncommon source of airway obstruction requiring a promt intervention as a result of possible complications. One of these is respiratory failure and ensuing cardiocirculatory aftermaths. The medical treatment are corticoids and interferon and in serious cases tumor removal or tracheotomy is indicated. The case presented is exceptional since it was treated by non invasive mechanical ventilation with nasal mask, owing to the patient's reject to surgery. The patient evolved favorably regarding the respiratory blockage, the same as the clinical course.

[Mechanical ventilation in patients with amyotrophic lateral sclerosis]. / Soporte ventilatorio en pacientes con esclerosis lateral amiotrófica.

INTRODUCTION AND DEVELOPMENT: In the final stage of amyotrophic lateral sclerosis, the majority of patients develop chronic respiratory failure. If these patients are not informed about the acute respiratory insufficiency, they run the risk of having to be intubated and stay in Intensive Care Unit over a long term; many of them die of respiratory failure without being informed about the available options. Prognosis and treatment options should be discussed with the patient and family. Their informed consent to prolonged mechanical ventilation of the lungs and stopped it under certain circumstances would be obtained before the condition progress to critical. The non invasive artificial home ventilation has led to advances in the management of patients with amyotrophic lateral sclerosis, as a longer period of survival with a higher level of quality of life. We also have analyzed ethical and social aspects and the results of long term mechanical ventilation in the literature.

Soporte ventilatorio en pacientes con esclerosis lateral amiotrófica / Mechanical ventilation in patients with amyotrophic lateral sclerosis

Introducción y desarrollo. Los pacientes con esclerosis lateral amiotrófica desarrollan insuficiencia respiratoria crónica en los estadios finales de la enfermedad. Si no se informa a estos enfermos de la posibilidad de tener un fallo respiratorio agudo, se corre el riesgo de precisar de intubación y de permanecer en la Unidad de Cuidados Intensivos durante un período prolongado. Muchos de ellos mueren de fallo respiratorio sin estar informados de las opciones disponibles. Su pronóstico y las opciones de tratamiento deberían discutirse con el paciente y sus familiares. La obtención del consentimiento informado para prolongar la ventilación mecánica o pararla en función de determinadas circunstancias debería conseguirse antes de llegar a una situación crítica. La ventilación mecánica no invasiva domiciliaria ha permitido avances en el tratamiento de pacientes con esclerosis lateral amiotrófica, con un aumento de la supervivencia y de la calidad de vida. Hemos analizado los aspectos éticos y sociales, así como los resultados de la ventilación mecánica no invasiva domiciliaria en la literatura (AU)