Effects of usual yoga practice on the diaphragmatic contractility: A cross-sectional controlled study.

Objectives: The aim of this study is to observe and compare the effects of regular yoga practice on the main inspiratory muscle, the diaphragm, by analyzing its thickness, excursion, velocity and contraction time, using ultrasound. Design: A Cross-Sectional Controlled Study. Participants: 80 healthy subjects (40 habitual yoga practitioners and 40 non-practitioners), without previous respiratory pathology participated in this study. During maximum diaphragmatic breathing, the diaphragmatic thickness (at rest and after maximum inspiration), excursion, velocity and contraction time were measured by ultrasound. Results: in the experimental group, practicing yoga, statistically significant differences (p < 0.001) were observed compared to the control group, not practicing, in the thickness of the diaphragm at rest (0.26 ± 0.02 vs 0.22 ± 0.01 cm); the diaphragmatic thickness in maximum inspiration (0.34 ± 0.03 vs 0.28 ± 0.03 cm); contraction velocity (1.54 ± 0.54 vs 2.23 ± 0.86 cm/s), contraction time (3.28 ± 0.45 vs 2.58 ± 0.49 s) and Borg scale of perceived exertion (1.05 ± 1.6 vs 1.70 ± 1.34), p = 0.05. However, the diaphragmatic excursion was greater in the control group (5.45 ± 1.42 vs 4.87 ± 1.33 cm) with no statistically significant differences (p = 0.06). Conclusions: the regular practice of yoga improves the parameters of diaphragm thickness, speed and contraction time measured in ultrasound and the sensation of perceived exertion during a maximum inspiration. So it can be considered as another method for training the inspiratory muscles in clinical practice.

Decrease in Readmissions after Hospitalisation for COPD Exacerbation through a Home Care Model.

Objective: To decrease readmissions at 30 and 90 days post-discharge from a hospital admission for chronic obstructive pulmonary disease exacerbation (COPDE) through the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU), increase patient survival at one year, and validate our readmission risk scale (RRS). Materials and methods: This was an observational study, with a prospective data collection and a retrospective data analysis. A total of 491 patients with a spirometry diagnosis of chronic obstructive pulmonary disease (COPD) requiring hospitalisation for an exacerbation were included in the study. Subjects recruited within the first year (204 cases) received conventional care (CC). In the following year a home care (HC) programme was implemented and of those recruited that year (287) 104 were included in the ACRCU, administered by a specialised nurse. Results: In the group of patients included in the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU) a lower number of readmissions was observed at 30 and 90 days after discharge (30.5% vs. 50%, p = 0.012 and 47.7% vs. 65.2%, p = 0.031, respectively) and a greater one-year survival (85.3% vs. 59.1%, p < 0.001). The validation of our RRS revealed that the tool's capacity to predict readmissions at both 30 and 90 days was not high (AUC = 0.69 and AUC = 0.66, respectively). Conclusions: The inclusion of exacerbator or fragile COPD patients in the ACRCU could achieve a decrease in readmissions and an increase in survival. The number of episodes of exacerbation within the 12 months prior to the hospital admission is the variable that best predicts the risk of readmission.

Objetivo: Disminuir los reingresos a los 30 y 90 días tras el alta por un ingreso hospitalario por exacerbación de enfermedad pulmonar obstructiva crónica (EPOC) a través del modelo de atención domiciliaria de la Unidad de Cuidados Crónicos Respiratorios Ambulatorios (UCCRA), aumentar la supervivencia al año y validar nuestra escala de riesgo de reingreso (ERR). Material y métodos: Estudio observacional con recogida prospectiva de datos. Se incluyó en el estudio a un total de 491 pacientes con diagnóstico espirométrico de enfermedad pulmonar obstructiva crónica que requirieron hospitalización por una agudización. Los sujetos reclutados dentro del primer año (204 casos) recibieron atención convencional (AC). Al año siguiente se implementó un programa de atención domiciliaria (AD) y de los pacientes reclutados ese año (287), 104 fueron incluidos en la UCCRA con seguimiento de una enfermera especializada. Resultados: En el grupo de pacientes incluidos en el modelo de atención domiciliaria de la UCCRA se observó un menor número de reingresos a los 30 y 90 días tras el alta (30,5% vs 50%, p = 0,012 y 47,7% vs. 65,2%, p = 0,031, respectivamente) y una mayor supervivencia al año (85,3% vs. 59,1%, p < 0,001). La validación de nuestra ERR reveló que la capacidad de la misma para predecir reingresos tanto a los 30 como a los 90 días no era alta (AUC = 0,69 y AUC = 0,66, respectivamente). Conclusiones: La inclusión de pacientes con EPOC agudizadores o frágiles en la UCCRA podría conseguir una disminución de los reingresos y una aumento de la supervivencia. El número de agudizaciones en los 12 meses previos al ingreso hospitalario es la variable que mejor predice el riesgo de reingreso.

Elevated levels of arginase activity are related to inflammation in patients with COPD exacerbation.

INTRODUCTION: Within the pathogenesis of the chronic obstructive pulmonary disease (COPD) there are interactions between different inflammatory mediators that are enhanced during an exacerbation. Arginase is present in bronchial epithelial cells, endothelial, fibroblasts and alveolar macrophages, which make it a probable key enzyme in the regulation of inflammation and remodelling. We aimed to find a potential relationship between arginase activity, inflammatory mediators in COPD patients in stable phase and during exacerbations. METHODS: We performed a prospective, observational study of cases and controls, with 4 study groups (healthy controls, stable COPD, COPD during an exacerbation and COPD 3 months after exacerbation). We measured arginase, inflammation markers (IL-6, IL-8, TNF-∝, IFN-γ and C reactive protein), and mediators of immunity: neutrophils, monocytes, total TCD3 + lymphocytes (CD3ζ), CD4 + T cells, CD8 + T cells, NK cells. RESULTS: A total of 49 subjects were recruited, average age of 69.73 years (59.18% male). Arginase activity is elevated during an exacerbation of COPD, and this rise is related to an increase in IL-6 production. The levels of IL-6 and IL-8 remained elevated in patients with COPD at 3 months after hospital exacerbation. We did not find a clear relationship between arginase activity, immunity or with the degree of obstruction in COPD patients. CONCLUSIONS: Arginase activity is elevated during an exacerbation of COPD, and it could be related to an increase in the production of IL-6. Levels of IL-6, IL-8, and arginase activity remain elevated in patients with COPD at 3 months after hospital exacerbation. Arginase activity could contribute to the development of COPD.

Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia.

INTRODUCTION: Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it. METHODS: We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020. RESULTS: A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%). CONCLUSIONS: TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.

Patient Management Assisted by a Neural Network Reduces Mortality in an Intermediate Care Unit / El manejo del paciente asistido por una red neuronal disminuye la mortalidad en una unidad de cuidados intermedios

INTRODUCTION: Mortality risk prediction for Intermediate Respiratory Care Unit's (IRCU) patients can facilitate optimal treatment in high-risk patients. While Intensive Care Units (ICUs) have a long term experience in using algorithms for this purpose, due to the special features of the IRCUs, the same strategics are not applicable. The aim of this study is to develop an IRCU specific mortality predictor tool using machine learning methods. METHODS: Vital signs of patients were recorded from 1966 patients admitted from 2007 to 2017 in the Jiménez Díaz Foundation University Hospital's IRCU. A neural network was used to select the variables that better predict mortality status. Multivariate logistic regression provided us cut-off points that best discriminated the mortality status for each of the parameters. A new guideline for risk assessment was applied and mortality was recorded during one year. RESULTS: Our algorithm shows that thrombocytopenia, metabolic acidosis, anemia, tachypnea, age, sodium levels, hypoxemia, leukocytopenia and hyperkalemia are the most relevant parameters associated with mortality. First year with this decision scene showed a decrease in failure rate of a 50%. CONCLUSIONS: We have generated a neural network model capable of identifying and classifying mortality predictors in the IRCU of a general hospital. Combined with multivariate regression analysis, it has provided us with an useful tool for the real-time monitoring of patients to detect specific mortality risks. The overall algorithm can be scaled to any type of unit offering personalized results and will increase accuracy over time when more patients are included to the cohorts

INTRODUCCIÓN: La predicción del riesgo de mortalidad de los pacientes en la unidad de cuidados respiratorios intermedios (UCRI) puede facilitar un tratamiento óptimo en pacientes de alto riesgo. Si bien las unidades de cuidados intensivos (UCI) tienen una experiencia a largo plazo en el uso de algoritmos para este propósito, debido a las características especiales de las UCRI, no se pueden aplicar las mismas estrategias. El objetivo de este estudio es desarrollar una herramienta de predicción de mortalidad específica para la UCRI utilizando métodos de aprendizaje automático. MÉTODOS: Se registraron los signos vitales de 1.966 pacientes ingresados entre 2007 y 2017 en la UCRI del Hospital Universitario de la Fundación Jiménez Díaz. Se utilizó una red neuronal para seleccionar las variables que mejor predijeran el estado de mortalidad. La regresión logística multivariante nos proporcionó los puntos de corte que discriminaban mejor el estado de la mortalidad para cada uno de los parámetros. Se aplicó una nueva guía para la evaluación de riesgos, y se registró la mortalidad durante un año. RESULTADOS: Nuestro algoritmo muestra que la trombocitopenia, la acidosis metabólica, la anemia, la taquipnea, la edad, los niveles de sodio, la hipoxemia, la leucocitopenia y la hipercalemia son los parámetros más relevantes asociados con la mortalidad. En el primer año con este escenario de decisión se mostró una disminución en la tasa de fracaso de un 50%. CONCLUSIONES: Hemos generado un modelo de red neuronal capaz de identificar y clasificar predictores de mortalidad en la UCRI de un hospital general. Combinado con el análisis de regresión multivariante, nos ha proporcionado una herramienta útil para la monitorización en tiempo real de pacientes para detectar riesgos de mortalidad específicos. El algoritmo general se puede modificar a escala para cualquier tipo de unidad, lo que ofrecerá resultados personalizados, y su precisión aumentará con el tiempo, según se incluyan más pacientes en las cohortes

Patient Management Assisted by a Neural Network Reduces Mortality in an Intermediate Care Unit.

INTRODUCTION: Mortality risk prediction for Intermediate Respiratory Care Unit's (IRCU) patients can facilitate optimal treatment in high-risk patients. While Intensive Care Units (ICUs) have a long term experience in using algorithms for this purpose, due to the special features of the IRCUs, the same strategics are not applicable. The aim of this study is to develop an IRCU specific mortality predictor tool using machine learning methods. METHODS: Vital signs of patients were recorded from 1966 patients admitted from 2007 to 2017 in the Jiménez Díaz Foundation University Hospital's IRCU. A neural network was used to select the variables that better predict mortality status. Multivariate logistic regression provided us cut-off points that best discriminated the mortality status for each of the parameters. A new guideline for risk assessment was applied and mortality was recorded during one year. RESULTS: Our algorithm shows that thrombocytopenia, metabolic acidosis, anemia, tachypnea, age, sodium levels, hypoxemia, leukocytopenia and hyperkalemia are the most relevant parameters associated with mortality. First year with this decision scene showed a decrease in failure rate of a 50%. CONCLUSIONS: We have generated a neural network model capable of identifying and classifying mortality predictors in the IRCU of a general hospital. Combined with multivariate regression analysis, it has provided us with an useful tool for the real-time monitoring of patients to detect specific mortality risks. The overall algorithm can be scaled to any type of unit offering personalized results and will increase accuracy over time when more patients are included to the cohorts.

Importancia del manejo especializado en el destete prolongado / The Importance of Highly Specific Management in Prolonged Weaning

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Self-reported walking and associated factors in the Spanish population with chronic obstructive pulmonary disease.

BACKGROUND: The level of physical activity among individuals with chronic obstructive pulmonary disease (COPD) is associated with the disease severity and prognosis. The aim of this study was to describe the prevalence of self-reported walking at least 150 min per week and the associated factors among the Spanish population with COPD. METHODS: Analyses were based on data drawn from the 2009 European Health Interview Survey in Spain (2009 EHIS). Twenty-two thousand one hundred eighty-eight subjects participated in the survey (response rate of 96.5%). Participants were classified according to international physical activity recommendations. The prevalence of walking among participants with and without COPD (≥40 years old) was described. Univariate and multivariate logistic regression models were used to study the association of walking with socio-demographic and health outcome variables. RESULTS: Of the participants with COPD, 55.0% reached the minimum walking recommendations compared to 59.9% of the general population. The level of walking physical activity of the participants with COPD differed according to sex, age, educational level, area of residence, living as a couple, self-rated health status, mental health, body mass index and hospital admissions. In the multivariate analysis, being male, < 65 years old, living in an area with ≥50,000 inhabitants, no diagnosed depression or anxiety and self-reported good to very good health were factors significantly associated with walking ≥150 min per week. CONCLUSIONS: Sex, age, area of residence, mental disorders and self-rated health are associated with weekly walking time in the Spanish population with COPD.

[Budesonide/formoterol in the treatment of COPD]. / Budesónida/formoterol en el tratamiento de la EPOC.

Two large, 12-month clinical trials have been performed with budesonide-formoterol in patients with stable COPD and have shown clear data on the efficacy of this combination in improving pulmonary function, symptoms and health-related quality of life and in reducing the number of exacerbations. Before these trials, information was already available on the efficacy of both monocomponents in this disease, although the main clinical data obtained with formoterol and budesonide separately in the treatment of COPD come from the respective branches of these drugs in the two large clinical trials described in the present article. Improvement in pulmonary function variables [forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF)] was always greater with the combination of budesonide-formoterol. The scores obtained in quality of life questionnaires were also more favorable in the combination treatment branches as early as the first week of treatment and persisted at 12 months of follow-up. Improvement in symptoms and in the use of reliever medication was also greater in the combination branch. The frequency of mild and severe exacerbations, as well as the use of oral corticosteroids, was lower in the budesonide-formoterol branch. The time to first exacerbation was also more prolonged in this group. The present review discusses the main findings on the efficacy of the combination of budesonide-formoterol in stable COPD.

Budesónida/formoterol en el tratamiento de la EPOC / Budesonide/formoterol in the treatment of COPD

Existen dos grandes ensayos clínicos realizados con la combinación de budesónida-formoterol en la EPOCestable a largo plazo que han mostrado unos claros datos acerca de la eficacia de esta combinación sobre lamejoría de la función pulmonar, los síntomas, la calidad de vida relacionada con la salud y sobre la reduccióndel número de exacerbaciones. Previamente a estos estudios, ya existía información acerca de la eficacia desus monocomponentes sobre esta misma enfermedad, aunque los principales datos clínicos obtenidos conformoterol y budesónida por separado en el tratamiento de la EPOC provienen del estudio de las respectivasramas de estos fármacos en los dos grandes ensayos clínicos que se describen en este artículo.Con respecto a la mejoría encontrada en las variables de función pulmonar (FEV1, FVC y PEF), siempre eramayor con la combinación de budesónida-formoterol. La puntuación obtenida en los cuestionarios de calidadde vida también fue más favorable en las ramas de tratamiento combinado ya desde la primera semana detratamiento y mantenida hasta los 12 meses de seguimiento, así como en la mejoría de los síntomas y en eluso de medicación de rescate. La frecuencia de exacerbaciones leves y graves, así como el uso de corticoidesorales, fue menor en el grupo tratado con budesónida-formoterol. De igual modo, el tiempo transcurridohasta la primera exacerbación también fue más prolongado en este mismo grupo.En esta revisión se ponen de manifiesto los principales hallazgos demostrados acerca de la eficacia de la combinaciónde budesónida-formoterol en la EPOC estable(AU)

Two large, 12-month clinical trials have been performed with budesonide-formoterol in patients with stableCOPD and have shown clear data on the efficacy of this combination in improving pulmonary function,symptoms and health-related quality of life and in reducing the number of exacerbations. Before these trials,information was already available on the efficacy of both monocomponents in this disease, although the mainclinical data obtained with formoterol and budesonide separately in the treatment of COPD come from therespective branches of these drugs in the two large clinical trials described in the present article.Improvement in pulmonary function variables [forced expiratory volume in one second (FEV1), forced vitalcapacity (FVC) and peak expiratory flow (PEF)] was always greater with the combination of budesonideformoterol.The scores obtained in quality of life questionnaires were also more favorable in the combinationtreatment branches as early as the first week of treatment and persisted at 12 months of follow-up.Improvement in symptoms and in the use of reliever medication was also greater in the combination branch.The frequency of mild and severe exacerbations, as well as the use of oral corticosteroids, was lower in thebudesonide-formoterol branch. The time to first exacerbation was also more prolonged in this group.The present review discusses the main findings on the efficacy of the combination of budesonide-formoterolin stable COPD(AU)

Marcadores pronósticos en la EPOC. Papel de la comorbilidad / Prognostic markers of COPD. Role of comorbidity

Una enfermedad crónica como la enfermedad pulmonar obstructiva crónica (EPOC) debe tener necesariamentemarcadores que pueden infl uir en su evolución o historia natural. El marcador mejor estudiado hasido el volumen espiratorio forzado en el primer segundo (FEV1), que clásicamente se ha considerado comoel mejor indicador pronóstico de la enfermedad. Junto a este parámetro hay otras variables que tambiénhan demostrado tener valor pronóstico. Se conoce la existencia de diferentes patrones evolutivos en la enfermedad,pero todavía se ha de reconocer que esta enfermedad es una desconocida desde el punto devista de la carencia de datos existentes acerca de su historia natural y de la incapacidad de predecir los casoscon mayor o menor progresión. Junto al FEV1 hay otros marcadores fi siopatológicos de la enfermedad,como el estado del intercambio de gases, el atrapamiento aéreo o la presencia de una hipertensión pulmonar.En este artículo se revisan las características de éstos, así como las de otros, clasifi cados en otros 2grandes grupos. Por un lado, el de los marcadores clínicos, como son el estado nutricional, la capacidad deejercicio, el índice BODE, que combina 4 parámetros (fi siopatológicos y clínicos) simultáneos y la presenciao no de excerbaciones frecuentes. Por otra parte, el de los marcadores biológicos potencialmente implicadosen la EPOC, como la proteína C reactiva, el estrés oxidativo y los mediadores que originan cambios enel músculo esquelético.La EPOC también predispone a la aparición de otras enfermedades asociadas o comorbilidades, que llegan apresentarse con más frecuencia por el hecho de tener una EPOC y que igualmente condicionan el pronósticode esta enfermedad(AU)

A chronic disease such as chronic obstructive pulmonary disease (COPD) will inevitably have biologicalmarkers infl uencing its natural history or progression. The most extensively studied marker is forcedexpiratory volume in 1 second (FEV1), classically recognized as the best prognostic indicator of the disease.Other physiopathological variables are also known to have prognostic value. The course of COPD showsseveral distinct patterns but data are lacking on the natural history of this disease and the ability to predictwhich patients will show greater or lesser progression. In addition to FEV1, there are other physiologicalmarkers of disease progression, such as gas interchange, air trapping, and pulmonary hypertension. Thepresent article reviews the characteristics of all these markers, as well as those of two other categories:clinical markers, such as nutritional status, exercise capacity, the BODE index, which combines fourphysiopathological and clinical parameters, and the occurrence or absence of frequent exacerbations.Finally, a group of biological markers, potentially implicated in COPD, such as C-reactive protein, oxidativestress and other variables affecting changes in skeletal muscle, are described.COPD also predisposes affected individuals to the presence of other associated diseases or comorbidities,which can occur more frequently because of the presence of COPD itself and can potentially infl uence theoutcome of this disease(AU)

[Evolution of patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or congestive heart failure in a respiratory monitoring unit]. / Evolución comparativa con ventilación no invasiva de pacientes con EPOC, síndrome de hipoventilación-obesidad e insuficiencia cardíaca congestiva ingresados en una unidad de monitorización respiratoria.

OBJECTIVE: We compared the use of noninvasive ventilation (NIV) for hypercapnic acidosis with hypoxemia in patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), or congestive heart failure (CHF) in a respiratory medicine monitoring unit. The objective was to evaluate each diagnostic groups response to therapy in terms of clinical course and evolution of blood gases. PATIENTS AND METHODS: Prospective, 12-month study of 53 patients with hypercapnic acidosis with hypoxemia. Twenty-seven patients had COPD, 17 OHS, and 9 CHF. Severity was assessed based on initial arterial blood gas analysis. Clinical course was studied by blood gas analysis after conventional treatment and after NIV (1-3 hours and 12-24 hours). Mortality was recorded. All patients received bilevel positive airway pressure support in assist-control mode. RESULTS: No significant differences were observed between mean (SD) initial pH findings in the 3 diagnostic groups: COPD, 7.28 (0.1); OHS, 7.29 (0.09); and CHF, 7.24 (0.07). (nonsignificant differences). After initial conventional treatment, PaCO2 worsened for COPD patients (P = .026) and PaO2 improved for CHF patients (P = .028). After 1 to 3 hours of NIV, pH (P = .002) and PaO2 (P = .041) improved for COPD patients, and pH (P = .03) and PaCO2 (P = .045) improved in OHS patients; no significant changes were observed in CHF patients. After 12 to 24 hours of NIV, the mean pH was 7.36 (0.04) for COPD patients, 7.36 (0.05) for OHS patients, and 7.25 (0.1) for CHF patients (not significant). The mortality rate was 11.1% for COPD, 0% for OHS, and 33.3% for CHS (not significant, P = .076). CONCLUSIONS: In this group of patients with similar initial arterial blood gas values, response to NIV was seen to be better in OHS and COPD than in CHF. That the start of NIV is usually preceded by a poor response to conventional COPD treatment suggests that delaying NIV should be reconsidered.

Evolución comparativa con ventilación no invasiva de pacientes con EPOC, síndrome de hipoventilación-obesidad e insuficiencia cardíaca congestiva ingresados en una unidad de monitorización respiratoria / Evolution of patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or congestive heart failure in a respiratory monitoring unit

OBJETIVO: Hemos realizado un trabajo comparativo en pacientes con enfermedad pulmonar obstructiva crónica (EPOC), síndrome de hipoventilación-obesidad (SHO) e insuficiencia cardíaca congestiva (ICC) sometidos a ventilación no invasiva (VNI) en una unidad de monitorización de neumología por presentar acidosis hipoxémica-hipercápnica. El objetivo ha sido valorar la respuesta clínica y gasométrica en función del diagnóstico. PACIENTES Y MÉTODOS: Se trata de un estudio prospectivo (12 mese de duración) en 53 pacientes con acidosis hipoxémic-hipercápnica, de los que 27 presentaban EPOC; 17, SHO, y 9, ICC. Realizamos un análisis de la gravedad gasométrica inicial, de la evolución gasométrica (tras tratamiento convencional y tras VNI a las 1-3h y 12-24h) y de la mortalidad. Todos ellos recibieron VNI tipo BiPAP en modo asistido-controlado. RESULTADOS: LA presentación gasométrica inicial era similar en las 3 entidades (valores medios +/- desviación estándar de pH, 7,28 +/- 0,1 en la EPOC; 7,29 +/- 0,09 en SHO, y 7,24 +/- 0,07 en ICC; no significativo). Tras tratamiento convencional inicial, en los pacientes con EPOC se observó un empeoramiento de la presión arterial de anhídrido carbónico (p=0,026), y en aquellos con ICC, una mejoría de la presión arterial de oxígeno (p=0,028). Tras el inico de la VNI (1-3h) se produjo una mejoría del pH (p=0,002) y de la presión arterial de oxígeno (p=0,041) en la EPOC, y del pH (p=0,03) y de la presión arterial de anhídrido carbónico (o=0,045) en el SHO; no hubo cambios significativos en la ICC. Tras 12-24h con VNI, el pH fue de 7,36 +/- 0,04 en la EPOC, de 7,36 +/- 0,05 en el SHO y de 7,25 +/- 0,1 (no significativo) en la ICC. La mortalidad fue del 11,1% en la EPOC, del 0% en el SHO y del 33% en la ICC (no significativo; p= 0,076). CONCLUSIONES: Partiendo de una gravedad gasométrica similar, en el SHO y la EPOC se observó una mejor respuesta a la VNI que en la ICC. El inicio de la VNI suele precederse de mala respuesta al tratamiento convencional en la EPOC, lo que haría replantearse la demora para iniciarla

OBJECTIVE: We compared the use of noninvasive ventilation (NIV) for hypercapnic acidosis with hypoxemia in patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), or congestive heart failure (CHF) in a respiratory medicine monitoring unit. The objective was to evaluate each diagnostic groups response to therapy in terms of clinical course and evolution of blood gases. PATIENTS AND METHODS: Prospective, 12-month study of 53 patients with hypercapnic acidosis with hypoxemia. Twenty-seven patients had COPD, 17 OHS, and 9 CHF. Severity was assessed based on initial arterial blood gas analysis. Clinical course was studied by blood gas analysis after conventional treatment and after NIV (1-3 hours and 12-24 hours). Mortality was recorded. All patients received bilevel positive airway pressure support in assist-control mode. RESULTS: No significant differences were observed between mean (SD) initial pH findings in the 3 diagnostic groups: COPD, 7.28 (0.1); OHS, 7.29 (0.09); and CHF, 7.24 (0.07). (nonsignificant differences). After initial conventional treatment, PaCO2 worsened for COPD patients (P=.026) and PaO2 improved for CHF patients (P=.028). After 1 to 3 hours of NIV, pH (P=.002) and PaO2 (P=.041) improved for COPD patients, and pH (P=.03) and PaCO2 (P=.045) improved in OHS patients; no significant changes were observed in CHF patients. After 12 to 24 hours of NIV, the mean pH was 7.36 (0.04) for COPD patients, 7.36 (0.05) for OHS patients, and 7.25 (0.1) for CHF patients (not significant). The mortality rate was 11.1% for COPD, 0% for OHS, and 33.3% for CHS (not significant, P=.076). CONCLUSIONS: In this group of patients with similar initial arterial blood gas values, response to NIV was seen to be better in OHS and COPD than in CHF. That the start of NIV is usually preceded by a poor response to conventional COPD treatment suggests that delaying NIV should be reconsidered