[A clinical practice guideline for diagnosis and treatment of chronic obstructive pulmonary disease]. / Guía de práctica clínica. Diagnóstico y tratamiento de la enfermedad pulmonar obstructiva crónica.

The World Health Organization (WHO) in 2000 considered that 274 million people died in the world because of chronic obstructive pulmonary disease (COPD). Global mortality by COPD depends on the stage of the disease and 30 to 48 % die during the next four to seven years after the diagnosis. The global burden of disease for the 2020 measurement through the years of potential life lost (YPLL) estimates that COPD is in the 10th place at world-wide level. The great variability in the care of the patients with COPD, as well as the increase in the number of patients with acute exacerbations makes necessary the development of a clinical practice guideline to standardize the treatment and the interventions of rehabilitation, nutrition in the three levels of health care with the objective to improve the quality of care and to promote the efficient use of the resources.

[Levosimendan in patients with acute cardiac failure]. / Uso de levosimendan en enfermos con falla cardíaca aguda.

OBJECTIVE: To assess levosimendan efficacy in acute cardiac failure. METHODS: We included 25 patients with acute cardiac failure and partial conventional therapy response defined as persistence of low cardiac output with inotropic support. We started levosimendan at loading dose and continuous infusion for 24 hours, recording hemodynamic data, as well as clinical variables. RESULTS: All patients showed clinical and hemodynamic improvement. Pulmonary wedge capillary pressure (PWCP) decreased from 18 cmH2O (11-30 cmH2O) to 14 cmH2O (8-15 cmH2O) at 12 hours (p = 0.3) and to 13 cmH2O (8-12 cmH2O) at the end of the infusion period (p = 0.2). Cardiac index increased from 2.1 L/min/m2 (1.8-3.5 L/ min/m2) to 2.86 L/min/m2 (2-4.3 L/min/m2) at 12 hours (p = 0.03) and to 3.08 L/min/m2 at the end of the infusion period (p = 0.02). Tachycardia higher than 120 bpm was present in six patients. No major hypotensive events were present. Mortality to the present is of eight patients. CONCLUSION: Levosimendan infusion improved hemodynamics and clinical variables in acute cardiac failure with few side effects in this small series of patients.

Uso de levosimendan en enfermos con falla cardíaca aguda / Levosimendan in patients with acute cardiac failure

Objetivo: Valorar el uso de levosimendan en el contexto de la falla cardíaca aguda. Material y métodos: Se incluyeron 25 pacientes que ingresaron o desarrollaron insuficiencia cardíaca aguda, con respuesta parcial al manejo habitual definida como la presencia de bajo gasto cardíaco a pesar de tratamiento inotrópico. Se inició levosimendan administrando una dosis de carga y se continuó con una infusión durante 24 horas, monitorizándose a los pacientes con un catéter de flotación pulmonar y registrándose los parámetros hemodinámicos, así como las variables clínicas de frecuencia cardíaca (FC) y presión arterial media (PAM). Resultados: Observamos mejoría clínica en todos los pacientes. Hemodinámicamente se documentó disminución de la presión capilar pulmonar (PCP) de 18 cmH2O (11-30 cmH2O) a 14 cmH2O (8-15 cmH2O) (p = 0.3) para las 12 horas de haberse iniciado la infusión y al final de 13 cmH2O (8-12 cmH2O) (p = 0.2.) Igualmente se observó mejoría en cuanto al índice cardíaco (IC) 2.1 L/min/m² (1.8-3.5 L/min/m²), a 2.86 L/min/m² (2-4.3 L/min/m²) (p = 0.03) a las 12 h de la infusión y manteniéndose de 3.08 L/min/m² (2.4-3.9 L/min/m²) al término de la infusión (p = 0.02.). Sólo 6 pacientes mostraron como complicación taquicardia con FC mayor de 120 x min, que fue transitoria y que no requirió manejo adicional. En ningún caso requirió iniciar infusión de algún vasopresor. La mortalidad hasta el momento es de 8 pacientes. Conclusión: El uso de levosimendan en pacientes con falla cardíaca aguda mejora las variables hemodinámicas y clínicas con pocos efectos adversos en esta población de estudio.

Objective: To assess levosimendan efficacy in acute cardiac failure. Methods: We included 25 patients with acute cardiac failure and partial conventional therapy response defined as persistence of low cardiac output with inotropic support. We started levosimendan at loading dose and continuous infusion for 24 hours, recording hemodynamic data, as well as clinical variables. Results: All patients showed clinical and hemodynamic improvement. Pulmonary wedge capillary pressure (PWCP) decreased from 18 cmH2O (11 -30 cmH2O) to 14 cmH2O (8-15 cmH2O) at 12 hours (p = 0.3) and to 13 cmH2O (8-12 cmH2O) at the end of the infusion period (p = 0.2). Cardiac index increased from 2.1 L/min/m² (1.8-3.5 L/ min/m²) to 2.86 L/min/m² (2-4.3 L/min/m²) at 12 hours (p = 0.03) and to 3.08 L/min/m² at the end of the infusion period (p = 0.02). Tachycardia higherthan 120 bpm was present in six patients. No major hypotensive events were present. Mortality to the present is of eight patients. Conclusion: Levosimendan infusion improved hemodynamics and clinical variables in acute cardiac failure with few side effects in this small series of patients.