Validity of lung ultrasound to rule out iatrogenic pneumothorax performed by pulmonologists without experience in this procedure.

INTRODUCTION: Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of lung ultrasound, conducted by pulmonologists without experience in this procedure, to tule out pneumothorax after invasive procedures. MATERIAL AND METHODS: Our prospective observational study consecutively included patients who underwent transbronchial lung biopsy (TBLB), therapeutic thoracentesis (TT) and/or transparietal pleural biopsies (PB) for whom subsequent chest radiography to rule out complications was indicated. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered in the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the "barcode" sign. RESULTS: We included 275 procedures (149 TBLBs, 36 BPs, 90 TTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. CONCLUSIONS: Lung ultrasound performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases.

Validez de la ecografía torácica para descartar neumotórax iatrogénico realizada por neumólogos sin experiencia en este procedimiento / Validity of lung ultrasound to rule out iatrogenic pneumothorax performed by pulmonologists without experience in this procedure

Introducción La ecografía ha demostrado ser una herramienta útil para el diagnóstico del neumotórax en manos expertas. Tras los procedimientos broncopleurales se recomienda realizar una radiografía de tórax para descartar complicaciones. Nuestro objetivo ha sido determinar la validez de la ecografía torácica para descartar neumotórax tras procedimientos invasivos, realizada por neumólogos sin experiencia en este procedimiento. Material y métodos Estudio observacional prospectivo que incluyó pacientes consecutivos sometidos a biopsia transbronquial (BTB), toracocentesis evacuadora (TE) y/o biopsias pleurales transparietales (BPT) a los que se les indicó radiografía de tórax posterior para descartar complicaciones. En todos los casos el mismo neumólogo que hizo la técnica, realizó una ecografía inmediatamente después del procedimiento. Se consideró diagnóstica de neumotórax la presencia de punto pulmonar o la combinación de los signos: ausencia de deslizamiento pleural, ausencia de líneas B y presencia del signo de «código de barras». Resultados Se incluyeron 275 procedimientos (149 BTB, 36 BPT, 90 TE) entre los que se produjeron 14 (5,1%) neumotórax iatrogénicos. La ecografía presentó una sensibilidad de 78,5%, una especificidad de 85%, y un valor predictivo positivo y negativo de 22% y 98,6%, respectivamente. La ecografía no permitió detectar la presencia de tres neumotórax, precisando uno de ellos drenaje torácico y diagnosticó adecuadamente dos neumotórax que no se detectaban en la radiografía inicial. Conclusiones La ecografía torácica realizada por neumólogos que inician su curva de aprendizaje permite descartar neumotórax con un valor predictivo negativo (VPN) del 98,6%, evitando realizar en un número considerable de casos estudios radiográficos de control innecesarios (AU)

Introduction Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of lung ultrasound, conducted by pulmonologists without experience in this procedure, to rule out pneumothorax after invasive procedures. Material and methods Our prospective observational study consecutively included patients who underwent transbronchial lung biopsy (TBLB), therapeutic thoracentesis (TT) and/or transparietal pleural biopsies (PB) for whom subsequent chest radiography to rule out complications was indicated. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered in the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the “barcode” sign. Results We included 275 procedures (149 TBLBs, 36 BPs, 90 TTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. Conclusions Lung ultrasound performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases (AU)

Validity of thoracic ultrasonography to rule out iatrogenic pneumothorax performed by pulmonologists without experience in this procedure. / Validez de la ecografía torácica para descartar neumotórax iatrogénico realizada por neumólogos sin experiencia en este procedimiento.

INTRODUCTION: Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of thoracic ultrasonography to rule out pneumothorax after invasive procedures, conducted by pulmonologists without experience in this procedure. MATERIAL AND METHODS: Our observational prospective study consecutively included patients who underwent transbronchial biopsy (TBB), evacuating thoracentesis (ECT) and/or transparietal pleural biopsies (TPB) who were indicated subsequent chest radiography to rule out complications. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the «barcode¼ sign. RESULTS: We included 275 procedures (149 TBBs, 36 TPBs, 90 ECTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and a positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. CONCLUSIONS: Thoracic ultrasonography performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases.

Predictores sociales y clínicos asociados con estancia hospitalaria prolongada en pacientes con agudización grave de EPOC / Social and clinical predictors associated with prolonged hospital stays for patients with severe exacerbation of chronic obstructive pulmonary disease

Objetivo: Analizar si existen factores sociales que influyan en la estancia hospitalaria prolongada (EHP) de pacientes con agudización grave de EPOC (AEPOC), además de factores clínico-demográficos. Metodología: Estudio de cohortes prospectivo. Se incluyeron pacientes consecutivos que ingresaron por AEPOC en un servicio de Neumología. Se registraron variables demográficas, clínicas (tabaquismo, exacerbaciones e infecciones, disnea, impacto según cuestionario CAT, función pulmonar, comorbilidades, oxigenoterapia y ventilación no invasiva) y sociales (situación económica, disponibilidad y sobrecarga de cuidador, dependencia en actividades básicas e instrumentales, riesgo social y uso de servicios sociales), utilizando cuestionarios e índices como Barthel, Lawton-Brody, Zarit, Barber y Gijón. Se realizó un análisis univariante y multivariante mediante un modelo de regresión logística. Resultados: Se incluyeron 253 pacientes, y la edad media fue de 68,9+/-9,8años. El 77,1% fueron varones. En el modelo de regresión logística se incluyeron tabaquismo activo, valor del FEV1, puntuación en CAT >10, disnea 3-4 de la mMRC, presencia de gérmenes en cultivos de esputo, comorbilidad cardiovascular, anemia, oxigenoterapia domiciliaria, vivir solo, residencia en zona rural, sobrecarga del cuidador y la detección de riesgo/problema sociofamiliar. Las variables que se asociaron de forma independiente con la posibilidad de una EHP fueron la puntuación en cuestionario CAT >10 (OR=8,9; p=0,04) y la detección de riesgo/problema sociofamiliar (OR=2,6; p=0,04). Fumar activamente fue predictor de estancia más breve (OR=0,15; p=0,002). Conclusiones: Variables relacionadas con la esfera social juegan un papel relevante en la estancia hospitalaria, además del impacto de la enfermedad y la persistencia del tabaquismo en pacientes con AEPOC graves

Objective: To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. Methodology: We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. Results: The study included 253 patients, with a mean age of 68.9+/-9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). Conclusions: Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation

Social and clinical predictors associated with prolonged hospital stays for patients with severe exacerbation of chronic obstructive pulmonary disease. / Predictores sociales y clínicos asociados con estancia hospitalaria prolongada en pacientes con agudización grave de EPOC.

OBJECTIVE: To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. METHODOLOGY: We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. RESULTS: The study included 253 patients, with a mean age of 68.9±9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). CONCLUSIONS: Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation.