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1.
J Clin Med ; 13(1)2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38202089

RESUMO

High-flow nasal cannula (HFNC) is a respiratory support technique that delivers a controlled concentration of oxygen with high flow, heat, and humidity via the nasal pathway. As it has many physiological effects, its use has increased for a variety of clinical indications; however, there is limited guidance on using HFNC as a respiratory support tool during endoscopic procedures. We conducted a narrative review to evaluate the effect of HFNC as an adjuvant tool during fiberoptic bronchoscopy (FOB), upper gastrointestinal tract endoscopy, and surgical procedures in adults. A search of the PubMed and Cochrane databases were performed. Approximately 384 publications were retrieved, and 99 were selected (93 original works and 6 case reports with a literature review). In patients who underwent FOB, HFNC appears to be superior to conventional oxygen therapy (COT) in preventing hypoxaemia. In contrast, for gastrointestinal endoscopy, the current evidence is insufficient to recommend HFNC over COT in a cost-effective manner. Finally, in surgical procedures such as laryngeal microsurgery or thoracic surgery, HFNC has been shown to be a safe and effective alternative to orotracheal intubation. As the results are heterogeneous, we advocate for the need for more quality studies to understand the effectiveness of HFNC during endoscopic procedures.

2.
Arch Bronconeumol ; 59(1): 27-35, 2023 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36273933

RESUMO

Pleural effusion (PE) is a common yet complex disease that requires specialized, multidisciplinary management. Recent advances, novel diagnostic techniques, and innovative patient-centered therapeutic proposals have prompted an update of the current guidelines. This document provides recommendations and protocols based on a critical review of the literature on the epidemiology, etiology, diagnosis, prognosis, and new therapeutic options in PE, and addresses some cost-effectiveness issues related to the main types of PE.


Assuntos
Derrame Pleural , Pneumologia , Cirurgia Torácica , Humanos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/terapia , Exsudatos e Transudatos , Toracentese/efeitos adversos , Toracentese/métodos
4.
Artigo em Inglês | MEDLINE | ID: mdl-35082492

RESUMO

PURPOSE: Home non-invasive ventilation (NIV) is recommended in patients with COPD and hypercapnic chronic respiratory failure (HCRF). The mechanism by it can improve alveolar ventilation during spontaneous breathing is not yet completely explained. Our aim is to evaluate the impact of on diaphragm muscle function in a series of patients with HCRF. PATIENTS AND METHODS: Observational, longitudinal, prospective study of a series of patients with very severe chronic obstruction to airflow treated with home high imntensity NIV (HINIV). Patients underwent a baseline and after 12 months assessment including adherence to treatment, quality of life, respiratory function tests and diaphragmatic ultrasound. SPSS v.26 software was used for statistical analysis. RESULTS: We studied 30 patients, 63% male, the mean age was 60.8 (±6.4) years old. Patients had a severe obstructive ventilatory pattern [FEV1 21.8 (±6.1)%] and hypercapnia [pCO2 56.4 (±7.2) mmHg]. After 12 months of HINIV, we observed significant increases in FVC of 9.2% (p = 0.002), FEV1 of 3.5% (p = 0.04), MIP of 9.4% (p = 0.006), and 6-minute-walking test (6MWT) of 31.9 m (p = 0.001), as well as decreases in paCO2 of 12.5 mmHg (p = 0.001), HCO3 of 4.7 mmol/L (p = 0.001) and BODE index from 7 to 6. Diaphragmatic ultrasound demonstrated an increase in the thickening fraction of 14% (p = 0.002). Respiratory symptoms (p = 0.04), physical function (p = 0.03), and sleep (p = 0.04) also improved. CONCLUSION: In patients with HCRF due to very severe chronic obstruction to airflow, long-term HINIV can improve respiratory performance by improving the function of the diaphragmatic musculature. Larger multicenter clinical trials are needed to confirm the results suggested in this study.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Insuficiência Respiratória , Diafragma/diagnóstico por imagem , Feminino , Humanos , Hipercapnia/diagnóstico , Hipercapnia/etiologia , Hipercapnia/terapia , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/métodos , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
5.
BMJ Open Respir Res ; 7(1)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33246973

RESUMO

BACKGROUND: Recessive mutations in the thymidine kinase 2 (TK2) gene cause a rare mitochondrial myopathy, frequently with severe respiratory involvement. Deoxynucleoside therapy is currently under investigation. RESEARCH QUESTION: What is the impact of nucleosides in respiratory function in patients with TK2-deficient myopathy? STUDY DESIGN AND METHODS: Retrospective observational study of patients treated with deoxycytidine and deoxythymidine. Evaluations were performed every 3 to 4 months after treatment during approximately 30 months. Forced vital capacity (FVC), maximuminspiratory and expiratory pressures (MIP/MEP), sniff nasal inspiratory pressure (SNIP), cough peak flow (CPF), arterial blood gas and nocturnal pulse oximeter (SpO2) were collected. RESULTS: We studied six patients, five of which were women, with a median age at onset of symptoms was 35.8 (range 5 to 60) years old. Patients presented a restrictive ventilatory pattern (median FVC of 50 (26 to 71)%) and severe neuromuscular respiratory weakness (MIP 38 (12 to 47)% and SNIP 14 (8 to 19) cmH2O). Four patients required ventilatory support before starting the treatment. FVC improved by 6%, proportion of sleep time with SpO2 <90% diminished from 14% to 0%, CPF increased by 23%, MEP increased by 73%, production and management of bronchial secretions improved and respiratory infections diminished. INTERPRETATION: Early detection of respiratory involvement requires an active search, even in asymptomatic patients. The nucleosides therapy may improve respiratory function, and stabilise the loss of respiratory capacity.


Assuntos
Desoxicitidina , Miopatias Mitocondriais , Músculos Respiratórios , Timidina , Adolescente , Adulto , Criança , Pré-Escolar , Desoxicitidina/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Miopatias Mitocondriais/diagnóstico , Miopatias Mitocondriais/tratamento farmacológico , Miopatias Mitocondriais/genética , Timidina/uso terapêutico , Timidina Quinase/genética , Capacidade Vital , Adulto Jovem
6.
Arch Bronconeumol ; 59(3): 178-179, 2023 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36243637

Assuntos
Bronquiectasia , Humanos
8.
Med Clin (Barc) ; 148(10): 449-452, 2017 May 23.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28238333

RESUMO

INTRODUCTION AND OBJECTIVE: Although sleep disordered breathing is common in patients with a severe chronic respiratory insufficiency (SCRI), there is few information on its prevalence. Our aim was to describe the prevalence and characteristics of the obstructive sleep apnea-hypopnea syndrome (OSAHS) in these patients. MATERIAL AND METHODS: Prospective and observational study carried out on patients with a SCRI included in a waiting list for a lung transplantation and who had undergone a standard polysomnography. RESULTS: A total of 105 patients were examined, of which 85 met the study's inclusion criteria. The prevalence of the OSAHS was 24.7%, with 19% of cases being severe. The most common underlying respiratory condition was COPD (62%). The OSAHS was linked to the male gender (P=.002), weight (P=.013), BMI (P=.034) and neck circumference (P=.01). Although most patients experienced symptoms suggestive of an OSAHS, the average score obtained in the Epworth Sleepiness Scale was low. CONCLUSIONS: We observed a high prevalence of OSAHS in patients with a SCRI but without clinical data suggestive of its diagnosis; hence, we believe that sleep studies should be carried out in these patients given the low pre-test clinical suspicion of the disease.


Assuntos
Insuficiência Respiratória/complicações , Apneia Obstrutiva do Sono/etiologia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Prevalência , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
9.
Arch Bronconeumol ; 53(8): 437-442, 2017 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28279517

RESUMO

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.


Assuntos
Asbestose/diagnóstico , Asbestose/terapia , Amianto/classificação , Amianto/toxicidade , Asbestose/diagnóstico por imagem , Asbestose/prevenção & controle , Biomarcadores Tumorais , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/terapia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/terapia , Programas de Rastreamento , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Mesotelioma/terapia , Fibras Minerais/análise , Fibras Minerais/toxicidade , Exposição Ocupacional , Saúde Ocupacional/legislação & jurisprudência , Doenças Pleurais/diagnóstico , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/terapia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/etiologia , Neoplasias Pleurais/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Testes de Função Respiratória , Fumar/epidemiologia , Espanha
11.
Arch Bronconeumol ; 50(6): 235-49, 2014 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-24698396

RESUMO

Although during the last few years there have been several important changes in the diagnostic or therapeutic methods, pleural effusion is still one of the diseases that the respiratory specialist have to evaluate frequently. The aim of this paper is to update the knowledge about pleural effusions, rather than to review the causes of pleural diseases exhaustively. These recommendations have a longer extension for the subjects with a direct clinical usefulness, but a slight update of other pleural diseases has been also included. Among the main scientific advantages are included the thoracic ultrasonography, the intrapleural fibrinolytics, the pleurodesis agents, or the new pleural drainages techniques.


Assuntos
Derrame Pleural/diagnóstico , Derrame Pleural/terapia , Algoritmos , Terapia Combinada , Diagnóstico por Imagem/métodos , Exsudatos e Transudatos/química , Humanos , Apoio Nutricional , Derrame Pleural/etiologia , Derrame Pleural/microbiologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Soluções Esclerosantes/uso terapêutico , Sensibilidade e Especificidade , Tuberculose Pleural/complicações , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/tratamento farmacológico
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