ABSTRACT
BACKGROUND: While the indication for noninvasive ventilation (NIV) in severely hypoxemic patients with acute heart failure (AHF) is often indicated and may improve clinical course, the benefit of early initiation before patient arrival to the emergency department (ED) remains unknown. OBJECTIVE: This study aimed to assess the impact of early initiation of NIV during emergency medical service (EMS) transportation on outcomes in patients with AHF. DESIGN: A secondary retrospective analysis of the EAHFE (Epidemiology of AHF in EDs) registry. SETTING: Fifty-three Spanish EDs. PARTICIPANTS: Patients with AHF transported by EMS physician-staffed ambulances who were treated with NIV at any time during of their emergency care were included and categorized into two groups based on the place of NIV initiation: prehospital (EMS group) or ED (ED group). OUTCOME MEASURES: Primary outcome was the composite of in-hospital mortality and 30-day postdischarge death, readmission to hospital or return visit to the ED due to AHF. Secondary outcomes included 30-day all-cause mortality after the index event (ED admission) and the different component of the composite primary endpoint considered individually. Multivariate logistic regressions were employed for analysis. RESULTS: Out of 2406 patients transported by EMS, 487 received NIV (EMS group: 31%; EMS group: 69%). Mean age was 79â years, 48% were women. The EMS group, characterized by younger age, more coronary artery disease, and less atrial fibrillation, received more prehospital treatments. The adjusted odds ratio (aOR) for composite endpoint was 0.66 (95% CI: 0.42-1.05). The aOR for secondary endpoints were 0.74 (95% CI: 0.38-1.45) for in-hospital mortality, 0.74 (95% CI: 0.40-1.37) for 30-day mortality, 0.70 (95% CI: 0.41-1.21) for 30-day postdischarge ED reconsultation, 0.80 (95% CI: 0.44-1.44) for 30-day postdischarge rehospitalization, and 0.72 (95% CI: 0.25-2.04) for 30-day postdischarge death. CONCLUSION: In this ancillary analysis, prehospital initiation of NIV in patients with AHF was not associated with a significant reduction in short-term outcomes. The large confidence intervals, however, may preclude significant conclusion, and all point estimates consistently pointed toward a potential benefit from early NIV initiation.
ABSTRACT
Se realizó un estudio descriptivo y transversal de los 13 menores de 18 años de edad con enfermedad fibroquística, atendidos en el Hospital Infantil Docente Sur de Santiago de Cuba, desde febrero de 2009 hasta julio de 2010, a fin de obtener los hallazgos imagenológicos de las afectaciones pleuropulmonares y sinusales, así como el estadio clínico en el que se encontraban. Se logró evaluar el pronóstico y gravedad de los pacientes, lo cual permitió indicar un tratamiento oportuno y adecuado.
A descriptive and cross-sectional study of the 13 children under 18 years of age with fibrocystic disease, assisted in the Teaching Southern Children Hospital in Santiago de Cuba was carried out from February, 2009 to July, 2010, in order to obtain the imaging findings of the pleuropulmonary and sinusal disorders, as well as the clinical stage in which they were. It was possible to evaluate the prognosis and the patients' severity, which allowed to indicate an opportune and appropriate treatment.
ABSTRACT
Se realizó un estudio descriptivo y transversal de los 13 menores de 18 años de edad con enfermedad fibroquística, atendidos en el Hospital Infantil Docente Sur de Santiago de Cuba, desde febrero de 2009 hasta julio de 2010, a fin de obtener los hallazgos imagenológicos de las afectaciones pleuropulmonares y sinusales, así como el estadio clínico en el que se encontraban. Se logró evaluar el pronóstico y gravedad de los pacientes, lo cual permitió indicar un tratamiento oportuno y adecuado(AU)
A descriptive and cross-sectional study of the 13 children under 18 years of age with fibrocystic disease, assisted in the Teaching Southern Children Hospital in Santiago de Cuba was carried out from February, 2009 to July, 2010, in order to obtain the imaging findings of the pleuropulmonary and sinusal disorders, as well as the clinical stage in which they were. It was possible to evaluate the prognosis and the patients' severity, which allowed to indicate an opportune and appropriate treatment(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Secondary Care , Diagnostic Imaging , Cystic Fibrosis , Cystic Fibrosis , Tomography Scanners, X-Ray Computed , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Se efectuó un estudio descriptivo y transversal de 196 pacientes con enfermedad cerebrovascular hemorrágica, que abarcó desde enero del 2004 hasta igual mes del 2005 en el Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, a los cuales se indicó una tomografía axial computarizada. Al relacionar las imágenes tomográficas con los síntomas y signos presentados por los enfermos, se halló lenguaje tropeloso en todos ellos; predominio de hematomas intraparenquimatosos, generalmente en ganglios basales y región temporal, así como primacía de la hipertensión arterial entre los antecedentes patológicos más importantes. Se concluyó que la tomografía axial computarizada es un medio para diagnóstico certero en las urgencias médicas por esa grave afección.
A descriptive and cross sectional study of 196 patients with cerebrovascular hemorrhagic disease was carried out from January, 2004 to the same month of 2005 in Saturnino Lora Teaching Provincial Hospital from Santiago de Cuba, to whom a computerized axial tomography was indicated. When relating the tomographic images with the symptoms and signs which they presented, trouble speaking was detected in all of them; prevalence of intraparenchymatous hematomas, generally in basal ganglia and temporal region, as well as prevalence of hypertension among the most important pathological history. It was concluded that computarized axial tomography is a mean for precise diagnosis in medical emergencies due to that serious disorder.
Subject(s)
Humans , Male , Aged , Stroke/diagnosis , Cerebral Hemorrhage , Tomography, X-Ray Computed , Cross-Sectional Studies , Epidemiology, DescriptiveABSTRACT
Se efectuó un estudio descriptivo y transversal de 196 pacientes con enfermedad cerebrovascular hemorrágica, que abarcó desde enero del 2004 hasta igual mes del 2005 en el Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, a los cuales se indicó una tomografía axial computarizada. Al relacionar las imágenes tomográficas con los síntomas y signos presentados por los enfermos, se halló lenguaje tropeloso en todos ellos; predominio de hematomas intraparenquimatosos, generalmente en ganglios basales y región temporal, así como primacía de la hipertensión arterial entre los antecedentes patológicos más importantes. Se concluyó que la tomografía axial computarizada es un medio para diagnóstico certero en las urgencias médicas por esa grave afección(AU)
descriptive and cross sectional study of 196 patients with cerebrovascular hemorrhagic disease was carried out from January, 2004 to the same month of 2005 in Saturnino Lora Teaching Provincial Hospital from Santiago de Cuba, to whom a computerized axial tomography was indicated. When relating the tomographic images with the symptoms and signs which they presented, trouble speaking was detected in all of them; prevalence of intraparenchymatous hematomas, generally in basal ganglia and temporal region, as well as prevalence of hypertension among the most important pathological history. It was concluded that computarized axial tomography is a mean for precise diagnosis in medical emergencies due to that serious disorder(AU)
Subject(s)
Humans , Male , Aged , Tomography, X-Ray Computed , Cerebral Hemorrhage , Stroke/diagnosis , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Se efectuó un estudio descriptivo y transversal para describir las características ecográficas de los órganos abdominales en 200 pacientes con diabetes mellitus, 19 de ellos insulinodependientes, atendidos en las respectivas consultas de endocrinología del Hospital Provincial Docente Saturnino Lora y Centro Provincial de Diabéticos de Santiago de Cuba desde mayo del 2006 hasta marzo del 2007. Entre las alteraciones ecográficas observadas, las más frecuentes fueron: aumento de ecogenicidad del páncreas, hígado y parénquima renal; estasis de la bilis, litiasis vesicular, vejiga neurogénica y ateromatosis de la aorta.
A descriptive and cross-sectional study was carried out to describe the echographic characteristics of the abdominal organs in 200 patients with diabetes mellitus, 19 of them were insulin-dependent patients, assisted in their respective Endocrinology visits from the Saturnino Lora Teaching Provincial Hospital and Provincial Center for Diabetics in Santiago de Cuba from May, 2006 to March, 2007. Among the echographic alterations observed, the most frequent were: increase of echogenicity of pancreas, liver and renal parenchyma; stasis of the bile, vesicular litiasis, neurogenic bladder and atheromatosis of the aorta.
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Diabetes Complications , Diabetes Mellitus/etiology , Diabetes Mellitus , Cross-Sectional Studies , Epidemiology, DescriptiveABSTRACT
Se efectuó un estudio descriptivo y transversal para describir las características ecográficas de los órganos abdominales en 200 pacientes con diabetes mellitus, 19 de ellos insulinodependientes, atendidos en las respectivas consultas de endocrinología del Hospital Provincial Docente Saturnino Lora y Centro Provincial de Diabéticos de Santiago de Cuba desde mayo del 2006 hasta marzo del 2007. Entre las alteraciones ecográficas observadas, las más frecuentes fueron: aumento de ecogenicidad del páncreas, hígado y parénquima renal; estasis de la bilis, litiasis vesicular, vejiga neurogénica y ateromatosis de la aorta(AU)
descriptive and cross-sectional study was carried out to describe the echographic characteristics of the abdominal organs in 200 patients with diabetes mellitus, 19 of them were insulin-dependent patients, assisted in their respective Endocrinology visits from the Saturnino Lora Teaching Provincial Hospital and Provincial Center for Diabetics in Santiago de Cuba from May, 2006 to March, 2007. Among the echographic alterations observed, the most frequent were: increase of echogenicity of pancreas, liver and renal parenchyma; stasis of the bile, vesicular litiasis, neurogenic bladder and atheromatosis of the aorta(AU)
