Gonzalo Segrelles Calvo

Ventilación mecánica no invasiva en una población anciana que ingresa en una unidad de monitorización respiratoria: causas, complicaciones y evolución al año de seguimiento

OBJECTIVE To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and 1 year later in comparison with the results from the younger age group (<75). MATERIAL AND METHODS Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH<7.35 and PaCO(2)>45 mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24 h), complications and evolution at the 1-year follow-up. RESULTS Mean age of the sample was 80.6. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the 1-year follow-up was 63.21%. CONCLUSIONS NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV.

Trastornos psicológicos y calidad de vida en pacientes con bronquiectasias no relacionadas con fibrosis quística

INTRODUCTION Patients with chronic bronchiectasis (BQ) may suffer from psychological disorders. The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit, using validated questionnaires. PATIENTS AND METHODS We included patients consecutively diagnosed with BQ (unrelated to cystic fibrosis) by high resolution computed tomography in the study. Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory, State-Trait Anxiety Inventory and St. Georges Respiratory Questionnaire, after signing the informed consent. They were classified according to their scores on the psychological screening questionnaires, and their results were compared with the clinical, radiological and functional parameters and Quality of Life. RESULTS Seventy patients were included, 48 women and 22 men, with a mean age of 64.19years. Thirty-four percent (34%) of patients showed symptoms of depression, and around 55% had scores above the 50th percentile in trait and state anxiety. The amount of sputum was associated with trait anxiety. Bacterial colonization was related to anxiety (trait and state), especially Pseudomonas aeruginosa colonization. Female patients showed a higher risk of depression. There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression. CONCLUSIONS A high percentage of patients with BQ presented anxiety (trait and state) and depression. The daily sputum production and bacterial colonization (especially with P. aeruginosa) were the variables most related to anxiety; depression was more common in women. We believe that the presence of psychological disorders should be evaluated, especially in patients with this profile.

Clinical Outcomes of Home Telemonitoring in Severe COPD

Introduction: Aim of this study was to sum up clinical evidence about telemedicine programs in severe COPD patients. Methodology: We conducted a clinical review about telemedicine programs in severe COPD patients. Our search strategy was based in selected all clinical trials published since 2000 about this topic. Results: Finally, we include 13 articles. In telemedicine group the number of Accident and Emergency Department visits and number of hospitalizations were lower than usual care group. Conclusions: Home telemonitoring appears to have a positive effect in reducing respiratory exacerbations and hospitalizations and improving quality of life.

Manifestaciones vasculares del adenocarcinoma pulmonar: a propósito de un caso

Occasionally, some neoplasia are associated with a hypercoagulable state (HCS) that increases the likelihood of thrombi formation (Trousseau sign) in the venous territory1; arterial involvement is uncommon. We present the case of a 58-year-old man who was seen in the emergency department of our hospital for symptoms of pleuritic pain in the right hemithorax, low-grade fever and hemoptoic expectoration. He was diagnosed with a pulmonary embolism (PE) in the right basal pyramid and a left parahilar mass infiltrating the left main pulmonary artery and tracheal carina; he also had bilateral mediastinal lymphadenopathies (Fig. 1). Bronchoscopy revealed an infiltrated carina, from which an underlying lesion protruded; a biopsy was taken, which was positive for lung adenocarcinoma. We requested Doppler ultrasound of the lower limbs, which confirmed deep vein thrombosis (DVT) in the right deep femoral/ popliteal territory. Forty-eight hours after admission to Respiratory Medicine, in spite of anticoagulant doses of low molecular weight heparin (LMWH), the patient experienced an episode of intense pain, with coldness and loss of pulse in the right foot. He was assessed by the Vascular Surgery department and diagnosed with acute arterial ischemia (AAI). An emergency thrombectomy was performed (histopathology of the thrombus was negative for malignancy), and sodium heparin infusion was started. The episode recurred at 5 and 14 days after admission. Repeat thrombectomy was performed after the second episode, but given the subsequent functional state of the right lower limb (RLL), pain that could not be controlled with opiate infusion, and in view of possible complications due to the start of chemotherapy (CT) treatment, we decided to amputate the RLL. The patient subsequently began chemotherapy, and has had no further episodes of arterial ischemia to date. The association between AAI and neoplasia is not as well defined as in the case of those of venous origin. Some neoplasia, particularly those that originate in the pancreas, lung and gastrointestinal tract, produce an HCS or cause a deficiency of some coagulant substances (proteins C and S, anti-thrombin III).2 In this patient, we found an

Polineuropatía periférica en un paciente con enfermedad pulmonar obstructiva crónica grave

. Hauri-Hohl A, Baenziger O, Frey B. Pneumomediastinum in the neonatal and paediatric intensive care unit. Eur J Pediatr. 2008;167:415–8. . Iver VN, Joshi AY, Ryu JH. Spontaneous pneumomediastinum. Analysis of 62 consecutive adult patients. Mayo Clin Proc. 2009;84:417–21. Carlos A. Rombolá a,∗, Mariela S. Plenc b y Pablo León Atance a a Servicio de Cirugía Torácica, Complejo Hospitalario Universitario