Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure.

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.

Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. / Sumario de las recomendaciones y puntos clave del Consenso de las Sociedades Científicas Españolas (SEPAR, SEMICYUC, SEMES; SECIP, SENeo, SEDAR, SENP) para la utilización de la ventilación no invasiva y terapia de alto flujo con cánulas nasales en el paciente adulto, pediátrico y neonatal con insuficiencia respiratoria aguda grave.

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.

[Sleep quality and adaptation to shift-work among ambulance staff in the Basque Country].

BACKGROUND: To explore the extent to which the shift-workers of emergency ambulances maintain an adequate sleep quality and adaptation to shift-work, and its relationship to personal, circadian rhythm, and work-related factors. METHODS: A cross-sectional study was performed on a sample of 180 technicians and nurses from the Emergency Medical Service of the Basque Country (18-60 years old) who were surveyed. The Pittsburgh Sleep Quality Index (PSQI), the Adaptation to Shift-Work Scale (ASW), the Circadian Type Questionnaire (CTQ) and the Composite Scale of Morningness (CSM) for evaluating chronotype, were administered. RESULTS: Fifty-two percent of the staff presented an intermediate adaptation and 30% reported a good adaptation. A progressive deterioration of sleep quality across the shifts (52% were bad sleepers during days-off, 63% after day-shifts and 90% after night-shifts) was related to a poorer level of adaptation to shift-work. A predictive model of adaptability was obtained based on the baseline level of sleep quality during the days-off and the V factor. The R factor moderated this interaction positively or negatively depending on sleep quality. CONCLUSIONS: There is a high presence of sleep disorders among the technicians and nurses of emergency ambulances as the main symptom of maladjustment to shift-work. Sleeping habits can cushion the impact of difficulties in resting and favor a better adaptation to shifts, introducing key-factors at the level of formation, prevention and intervention.

Calidad del sueño y adaptación a los turnos rotatorios en trabajadores de ambulancias de emergencias del País Vasco / Sleep quality and adaptation to shift-work among ambulance staff in the Basque Country

FUNDAMENTO: Explorar la calidad del sueño y la adaptación a la turnicidad del personal de ambulancias de urgencias y su relación con factores sociodemográficos, circadianos y laborales. MATERIAL Y MÉTODOS: Estudio transversal sobre 180 técnicos y enfermeros (18-60 años) de la Red de Transporte Sanitario Urgente del País Vasco realizado mediante encuestas. Se emplearon el Pittsburgh Sleep Quality Index (PSQI) para evaluar la calidad del sueño, la Escala de Adaptación al Turno de Trabajo (ATT), el Circadian Type Questionnaire (CTQ) de hábitos de sueño, y la Composite Scale of Morningness (CSM) para valorar el cronotipo. RESULTADOS: El 52% presentó una adaptación intermedia y el 30% buena. El progresivo deterioro de la calidad del sueño a lo largo de la turnicidad (pobre calidad durante los días libres en el 52% de trabajadores, 63% tras turnos de día y 90% tras turnos de noche) se relacionó con una peor adaptación. Se obtuvo un modelo predictivo de la adaptabilidad partiendo del nivel basal de calidad del sueño durante los días libres y la vigorosidad para vencer la somnolencia. El factor rigidez de hábitos de sueño moderó positiva o negativamente esta interacción en función de la buena o mala calidad del sueño. CONCLUSIONES: Las alteraciones del sueño son frecuentes entre el personal de ambulancias de urgencias, como principal síntoma de desadaptación a los turnos inherentes a su actividad. Los hábitos de sueño parecen amortiguar el impacto de las dificultades del descanso y favorecer la adaptación a los turnos, aportando factores claves a nivel de formación, prevención e intervención

BACKGROUND: To explore the extent to which the shift-workers of emergency ambulances maintain an adequate sleep quality and adaptation to shift-work, and its relationship to personal, circadian rhythm, and work-related factors. METHODS: A cross-sectional study was performed on a sample of 180 technicians and nurses from the Emergency Medical Service of the Basque Country (18-60 years old) who were surveyed. The Pittsburgh Sleep Quality Index (PSQI), the Adaptation to Shift-Work Scale (ASW), the Circadian Type Questionnaire (CTQ) and the Composite Scale of Morningness (CSM) for evaluating chronotype, were administered. RESULTS: Fifty-two percent of the staff presented an intermediate adaptation and 30% reported a good adaptation. A progressive deterioration of sleep quality across the shifts (52% were bad sleepers during days-off, 63% after day-shifts and 90% after night-shifts) was related to a poorer level of adaptation to shift-work. A predictive model of adaptability was obtained based on the baseline level of sleep quality during the days-off and the V factor. The R factor moderated this interaction positively or negatively depending on sleep quality. CONCLUSIONS: There is a high presence of sleep disorders among the technicians and nurses of emergency ambulances as the main symptom of maladjustment to shift-work. Sleeping habits can cushion the impact of difficulties in resting and favor a better adaptation to shifts, introducing key-factors at the level of formation, prevention and intervention

Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2 / Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una Unidad de Cuidados Intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials

Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2 / Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una Unidad de Cuidados Intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials

Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection. / Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

[Validity of a portable recording system (MESAM IV) for the diagnosis of sleep apnea syndrome]. / Validez de un sistema de registro portátil (MESAM IV) para el diagnóstico del síndrome de apnea del sueño.

The development of inexpensive tools for diagnosing sleep apnea syndrome (SAS) is a result of the high prevalence of this condition and of the high cost of polysomnograms (PS). MESAM IV is a portable device that records changes in oxygen saturation (SO2), heart rate (HR) and snoring (S). Readings can be automatic or manual, the latter in function of an events index (EI), with a graph of the three variables generated. We carried out a simultaneous study of 51 subjects suspected of having SAS who were referred to the sleep unit by the pneumology outpatient clinic. PS was interpreted manually at 30-sec intervals as recommended by the American Thoracic Society. An apnea/hypoapnea index (AHI) > or = 10/hour of sleep was used as the cutoff point for SAS. Thirty-two (63%) subjects were found to have SAS as indicated by PS. The rate of agreement between AHI and automatic analysis of SO2, HR and S was only moderate (intra-group correlation coefficients -ICC- of 0.50, 0.40, and 0.53, respectively) and was inferior to manual analysis with EI (ICC of 0.77). Assessment of diagnostic efficacy of automatic analysis in terms of sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) yielded the following results: SO2 (SEN 94%, SPE 26%, PPV 68% and NPV 71%), HR (SEN 59%, SPE 58%, PPV 70%, NPV 46%); S (SEN 84%, SPE 26%, PPV 66%, NPV 50%). Manual analysis (EI) gave more valid results (SEN 100%, SPE 84%, PPV 91%, NPV 100%). If patients with chronic obstructive lung disease are excluded, however, the results for automatic analysis improve: SEN 100%, SPE 91%, PPV 96%, NPV 100%. These results show that MESAM IV is of great help in diagnosing SAS, allowing better screening for identifying candidates for PS.