Recomendaciones para la realización de broncoscopia y técnicas pleurales en la pandemia COVID-19 / No disponible

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Obstrucción de la vía aérea central por enfermedad inflamatoria intestinal y rescate terapéutico con membrana de oxigenación extracorpórea / Central airway obstruction due to inflammatory bowel disease and rescue with extracorporeal membrane oxygenation

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Oclusión bronquial endoscópica con prótesis de silicona de wata-nabe y pegamento biológico para el tratamiento de fístulas bronco-pleurales / Endoscopic bronchial occlusion with a Watabane silicone prosthesis and biological glue for the treatment of bronchopleural fistulas

Introducción: La fístula broncopleural (FBP) es la comunicación del árbol bronquial con el espacio pleural y su existencia supone un serio problema por su morbimortalidad asociada. El objetivo es evaluar una técnica de oclusión bronquial endoscópica con prótesis de silicona (..) (AU)

Introduction: Bronchopleural fistula (BPF) is the communication of the bronchial tree and pleural space, and its existence supposes a serious problem for its associated morbid-mortality. The objective is to evaluate a technique of endoscopic (..) (AU)

Evaluación de la aplicación de ventilación mecánica no invasiva para el fracaso ventilatorio agudo en planta de hospitalización convencional / Evaluation of the application of non-invasive mechanical ventilation for acute respiratory insufficiency in a pulmonary hospital ward

Introducción: La ventilación mecánica no invasiva (VMNI) es un tratamiento eficaz para el tratamiento de la insuficiencia respiratoria en determinadas patologías. El objetivo del estudio es evaluar la experiencia en nuestro hospital en la aplicación de la VMNI en pacientes con insuficiencia respiratoria (..) (AU)

Introduction: Non-invasive mechanical ventilation (NIMV) is an effective treatment for respiratory insufficiency in certain pathologies. The (..) (AU)

Broncoscopia terapéutica flexible / No disponible

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Fiabilidad de la presión transcutánea de anhídrido carbónico en pacientes / Reliability of trancutaneous carbon dioxide pressure in patients with exacerbated chronic respiratory insufficiency

Introducción: la determinación de la presión de CO2 es un elemento clave en el manejo de la insuficiencia respiratoria crónica agudizada. El "patrón oro" es la obtención de una muestra (..) (AU)

Background: pCO2 measurement plays a key role in the management of Acute-on.Chronic Respiratory Failure (ACRF) and arterial (..) (AU)

Braquiterapia endobronquial / No disponible

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Utilidad de la fibrobroncoscopia en las intubaciones traqueales difíciles / Usefulness of fiberoptic bronchoscopy for difficult tracheal intubations

La fibrobroncoscopia (FB) representa una gran ayuda para la realización de intubaciones difíciles o fallidas por los métodos convencionales. Nuestro objetivo fue conocer el número de intubaciones realizadas mediante FB, así como características de las mismas y analizar los problemas detectados en base a la experiencia acumulada. Metodología: Se recogieron todas las intubaciones realizadas con control de FB, desde enero de 1996 hasta Octubre de 2005.En ésta figuraban el servicio solicitante de la intubación y el de procedencia del paciente, el motivo de la intubación y complicaciones de la técnica. Resultados: Se realizaron un total de 4291 FB delas cuales el 11% fueron intubaciones guiadas con FB. La edad media fue 53,6 años, siendo el 77,2% varones. Casi todas las intubaciones fueron solicitadas por el servicio de anestesia (95,7%).Los servicios de procedencia de los pacientes fueron cirugía general32%, cirugía maxilofacial (MXF) 31,1%, traumatología 14,7%,Otorrinolaringología (ORL) 8,3%, Unidad de Cuidados Intensivos/Unidad de Reanimación Postoperatoria 4,3%, neurocirugía4,1% y otros 5,3%. Las indicaciones fueron intubaciones bronquiales selectivas 23%, tumores MXF 22,6%, rigidez cervical8,5%, limitación en la apertura de la boca 8,3%, obesidad 7%,tumores ORL 4,3%, fracturas MXF, síndrome de apnea del sueño y espondilitis anquilosante el 3,6% respectivamente, patología tiroidea, artritis reumatoide y reintubación el 3,2% y otros en el5,3%. Se produjeron complicaciones (4,2%) todas de escasa importancia. En 5 casos (1%) no se consiguió la intubación con control FB. Conclusiones: la intubación guiada con FB es una técnica segura y con una elevada rentabilidad en los casos de intubaciones difíciles o fallidas con los medios convencionales

The fiber optic bronchoscopy (FB) represents a great help for difficult or failed intubations by conventional methods. The objective was to know the number of intubations performed by FB, as well as the characteristics of these intubations and, in our experience, to analyze the problems detected during these intubations. Methodology: we analyzed in a data base all the intubations performed by FB guidance, from January 1996 to October 2005. In this database we recorded the services that had asked for the intubation, the admission service of the patient, the reason for the intubation and complications. Results: From a total of 4.291 FB performed,11% were FB to guide intubations. Almost all the intubations were asked for by the an a esthesiology service (95.7%).The admission services of the patients were General Surgery 32%,Maxillofacial (MF) Surgery 31.1%, Traumatology 14.7%, Otorhinolaryngology(ORL) 8.3%, Intensive Care Unit/Postoperative Reanimation Unit 4.3%, Neurosurgery 4.1%, and other services5.3%. The most frequent reasons for the intubations were selective bronchial intubations 23%, MF tumors 22.6%, cervical rigidity8.5%, limitations in the opening of the mouth 8.3%, obesity 7%,ORL tumors 4.3%, MF fractures, sleep apnea syndrome and ankylosing spondylitis 3.6% respectively, thyroid diseases, rheumatoid arthritis and reintubation 3.2% and other 5.3%. We recorded a4.2% rate of mild complications, all of little importance. In 5 cases(1%) the intubation guided by FB was impossible. Conclusions: The intubation guided by FB is a safe technique and with a high yield in the cases of difficult or failed intubations by conventional methods

Cuidados paliativos en el paciente respiratorio terminal / Paliative care in the terminal respiratory patient

El envejecimiento progresivo de la población hace que lasenfermedades crónicas sean cada vez mas frecuentes en nuestroquehacer diario y las situaciones en que estos pacientes precisencuidados paliativos es cada vez mayor. En la presente revisión seanalizan definiciones generales y normativas médico-legales, criteriosde terminalidad de la enfermedad pulmonar avanzada, organizaciónde un programa de cuidados paliativos, manejo y tratamientode los problemas mas frecuentes (disnea, dolor, tos yproblemas propios del cáncer de pulmón como derrame pleural,hemoptisis, síndrome de vena cava superior, metástasis óseas ymetástasis cerebrales). Se hace especial hincapié en el conocimientodel manejo y tratamiento de la enfermedad terminal, incluyendolos principios éticos que deben regir nuestras actuaciones,medidas finales y sedación paliativa y en la agonía

The progressive ageing of the population means that chronicdiseases are evermore frequent in our daily practice and the situationsof these patients in palliative care is equally frequent. Thispresent review analyzes the general definitions and medical-legalnorms, criteria for advanced terminal lung diseases, the organizationof palliative care, management and treatment of the most frequentproblems (dyspnea, pain, coughing and the standard lungcancer problems such as pleural effusion, haemoptysis, upper venacava syndrome, bone metastasis and cerebral metastasis). Knowingthe management and treatment in terminal patients is stressed,including ethical principles which must guide our actions, final measures and palliative sedation and during expiration (AU)

Fármacos inhibidores de la agregación plaquetaria y sangrado en broncoscopia / Platelet aggregation inhibitors and bronchoscopic bleeding

El sangrado en broncoscopia es una complicación temida quepuede llevar a complicaciones serias durante la realización de latécnica. Sin embargo, a pesar del potencial peligro para elpaciente, si se realiza una revisión de la literatura, el sangrado trasla toma de muestras broncoscópicas es una complicación relativamenteinfrecuente y, en la mayoría de los casos, con pocas repercusionesclínicas. Desde hace varios años existe cierta incertidumbresobre la necesidad de suspender o no la toma de fármacos inhibidoresde la agregación plaquetaria antes de realizar una broncoscopiacon objeto de minimizar el riesgo de sangrado. En este sentido,existen diversas publicaciones al respecto con informacióndiversa y, en ocasiones, contradictoria. En esta revisión se recogenlos principales factores relacionados con esta complicación, lamagnitud del problema, el mecanismo de acción de estos fármacosy su relación con el sangrado tras la toma de muestras broncoscópicas

Bleeding during bronchoscopy is a fearsome complication thatcan lead to serious complications during the procedure. Nonetheless,when a review of the literature is performed, bleeding afterbronchoscopic sampling is a relatively infrequent complicationand with few clinical implications in most cases. Recently, somecontroversy has aroused regarding the need for suspending plateletaggregation inhibitors therapy before the performance of thebronchoscopy in order to minimize bleeding risk. In this sense,several publications have been published with diverse and in somecases contradictory information. In this review the main factorsrelated to this complication, the magnitude of the problem, themechanism of action of these drugs and their relationship withbronchoscopic bleeding are documented

Ventilación mecánica no invasiva en planta de hospitalización / Noninvasive ventilation on the ward

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Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure.

BACKGROUND: Although non-invasive ventilation (NIV) efficacy in the treatment of acute hypercapnic respiratory failure (AHRF) have been previously demonstrated, not all the studies reveal this fact in the same degree, with some variability in the results. This study aimed to analyse variables related to NIV outcome for AHRF. METHODS: A group of consecutive patients requiring NIV due to AHRF were included in a prospective observational cohort study performed in conventional wards. Variables considered included those reported in the literature, as well as staff problems during the management of the ventilators. The study aimed to include all patients during one year, but after the initial results, it had to be suspended. RESULTS: Fifteen patients were included in the study: 10 males, mean age 68+/-12. APACHE-II score was 17.6+/-6.5. pH and pCO2 before NIV were 7.22+/-0.11 and 110+/-72 mmHg respectively. pH, corticosteroids use, APACHE score, and EPAP were found to influence outcome. Besides, an inadequate use of NIV due to lack of personnel training was detected in all patients with NIV failure (RR 3.5; 95% CI: 1.08-11.2; p = 0.007). In the light of these results, the study had to be suspended and patients were transferred to the respiratory ward. CONCLUSIONS: NIV is a life-saving respiratory treatment influenced by several factors, of which staff training is a key one. Centres attending acute respiratory patients should have an area in which this requirement is fulfilled.

[Setting up written informed consent for fiberoptic bronchoscopy in the pneumology units of Spanish hospitals]. / Indice de implantación del consentimiento informado escrito para fibrobroncoscopia en las unidades de neumología de los hospitales españoles.

OBJECTIVES: To assess the implantation and quality of written IC in the pulmonology units of Spanish hospitals. METHOD: A descriptive study was initiated with a nation-wide mail and/or telephone survey of 117 Spanish hospitals to determine whether or not written ICs were signed before fiberoptic bronchoscopy. If the respondents answered affirmatively, a copy of the form was requested for evaluation. Evaluation criteria were a) whether IC was specific for fiberoptic bronchoscopy, and if it was, b) whether it contained information as well as a declaration of consent, and c) whether the information and declaration were adequate, fulfilling minimum requirements. RESULTS: Seventy-three pulmonology units (60%) responded and 49 of them (67.1%) reported that they obtained written ICs while 24 (32.9%) did not. Of the 49 departments that reported asking for written IC, 41 (83%) used forms that were specific for fiberoptic bronchoscopy and 8 (17%) used nonspecific forms. The 41 units with specific IC forms submitted papers containing both information and declaration sections. The information was adequate in 10 cases (24%) and the declaration was appropriate in 17 (41%); only 6 (14%) had both adequate information and an appropriate declaration. CONCLUSIONS: Written ICs are increasingly common and are present in 67% of the pulmonology units that responded to the questionnaire. The low number of forms meeting minimum requirements is remarkable. It would be useful to design an IC form that respects our specific sociocultural context for use nation-wide in Spain.

[Pneumonia due to varicella zoster virus in adults: a review of 13 cases]. / Neumonía varicelosa en adultos: revisión de 13 casos.

Pneumonia due to varicella-zoster virus is a complication of chickenpox that appears almost solely in adults. The clinical picture ranges from varieties with few symptoms to those with severe respiratory insufficiency. This retrospective study of adult varicella pneumonia cases treated at our hospital over a seven-year period enrolled 13 patients (9 men and 4 women) whose diagnosis of varicella pneumonia was based on clinical and radiologic criteria during the course of disease. Three patients were immunodepressed (two with HIV infection and one with systemic lupus) and one patient was in her third month of pregnancy. Seventy-seven percent of the patients were active smokers. The most common symptoms apart from skin rash and fever were coughing and dyspnea. All had extensive bilateral nodular patterns visible on the chest film, with no pleural involvement or mediastinal adenopathy. All received intravenous acyclovir and outcome was good in all but one HIV-infected patient, who died. The pregnant patient required intensive care.