ABSTRACT
The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS). Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital follow-up; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C). 66 patients were included (22 per branch), 83% were males, aged mean±sd 52±10 yrs, body mass index 34±7kg·m(-2), apnoea/hypopnoea index 43±20 h(-1), CPAP pressure 8±2 cmH(2)O, with no between-group differences. Clinical response showed an ESS of mean±sd 15±3 to 6±4, a FOSQ of 16±3 to 18±2, symptoms of 43±7 to 25±7, and activity of 37±11 to 25±8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A 590±43, group B 894±11 and group C 644±93 (p<0.001). In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.
Subject(s)
Ambulatory Care/methods , Continuous Positive Airway Pressure/methods , Home Care Services , Polysomnography , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/therapy , Adult , Continuous Positive Airway Pressure/nursing , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Compliance , Polysomnography/nursing , Sleep Apnea, Obstructive/nursing , Surveys and QuestionnairesABSTRACT
BACKGROUND: Various methods have been described for safely performing fiberoptic bronchoscopy (FB) while applying non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure (ARF). OBJECTIVES: To evaluate the safety of a new method to perform FB in patients with ARF. METHODS: Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S(a)O(2)) after the procedure. During nasal NIPPV, FB was performed via the mouth using a bite block sealed with an elastic glove finger allowing bronchoscope insertion. RESULTS: Thirty-five patients were included in the final study (63 ± 17 years, 74% men, P(a)O(2)/F(i)O(2) ratio 168 ± 63). A total of 35 bronchoaspirates, 21 protected brushings, 11 bronchoalveolar lavages and 8 bronchial biopsies were done. The cardiorespiratory variables at the start and end of FB were: S(a)O(2) 93 ± 3 to 94 ± 5%, heart rate 95 ± 17 to 99 ± 22 b.p.m. and respiratory rate 24 ± 11 to 25 ± 11 respirations/min. The lowest S(a)O(2) value reached during the procedure was 86 ± 3% and the maximal ETCO(2) rise was 41 ± 4 mm Hg. Leakage was <50 ml/s in 32 patients. The clinical course was favorable in 66%. Invasive ventilation was necessary in 11%, 5 ± 4 days after FB. Twelve patients (33%) died 3 ± 2 days after FB as a result of their underlying disease. CONCLUSIONS: The system allowed to perform FB safely in patients with ARF. Although there is a relatively high rate of intubation and invasive mechanical ventilation due to illness severity, there was no worsening of oxygenation or complications attributable to the procedure.
Subject(s)
Bronchoscopy/instrumentation , Respiratory Distress Syndrome/diagnosis , Adult , Aged , Aged, 80 and over , Female , Fiber Optic Technology , Humans , Male , Middle Aged , Prospective StudiesSubject(s)
Asthma/diagnosis , Lung/metabolism , Mast Cells/pathology , Mastocytosis, Systemic/diagnosis , Abdominal Pain , Acetates/therapeutic use , Anti-Asthmatic Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Asthma/complications , Asthma/physiopathology , Asthma/therapy , Budesonide/therapeutic use , Capillary Permeability/drug effects , Cough , Cyclopropanes , Diarrhea , Dyspnea , Female , Humans , Lung/drug effects , Lung/pathology , Mast Cells/drug effects , Mastocytosis, Systemic/complications , Mastocytosis, Systemic/physiopathology , Mastocytosis, Systemic/therapy , Middle Aged , Nedocromil/therapeutic use , Quinolines/therapeutic use , SulfidesABSTRACT
We present a case of pulmonary thromboembolism in a young patient triggered by a long haul travel, in which a homocygotic mutation in the gene of the metilentetrahidrofolate reductase was demonstrated. This mutation can cause hyperhomocysteinemia that is a recognized risk factor for venous thromboembolism (VTE). In the management of these patients, the levels of homocysteine should be lowered, as well as use of thromboprophylaxis before transitory risk situations. It is important to know when the screening should be performed, because they are behind an important number of cases of VTE.
Subject(s)
Pulmonary Embolism/etiology , Travel , Adult , Humans , MaleABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Lymphoma/complications , Lymphoma/diagnosis , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Radiography, Thoracic/methods , Biomarkers/analysis , Immunotherapy/methods , Cyclophosphamide/therapeutic use , Lung Neoplasms/therapy , Lung Neoplasms , Lymphoma, Non-Hodgkin/complications , Cough/complications , Vincristine/therapeutic use , Prednisone/therapeutic useABSTRACT
Presentamos un caso de tromboembolismo pulmonar en paciente joven desencadenada por un viaje de larga duración, en el que se demostró una mutación homocigota en el gen de la metilentetrahidrofolato reductasa. Esta mutación puede provocar una hiperhomocisteinemia, que es un factor de riesgo conocido para enfermedad tromboembólica venosa (ETV). En el manejo de estos pacientes se deben descender los niveles de homocisteína, así como realizar profilaxis tromboembólica ante situaciones de riesgo transitorias. Es importante conocer cuándo debe ser realizado su screening, ya que se encuentran detrás de un importante número de casos de ETV
We present a case of pulmonary thromboembolism in a young patient triggered by a long haul travel, in which a homocygotic mutation in the gene of the metilentetrahidrofolate reductase was demonstrated. This mutation can cause hyperhomocysteinemia that is a recognized risk factor for venous thromboembolism (VTE). In the management of these patients, the levels of homocysteine should be lowered, as well as use of thromboprophylaxis before transitory risk situations. It is important to know when the screening should be performed, because they are behind an important number of cases of VTE
Subject(s)
Humans , Male , Adult , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Hyperhomocysteinemia/complications , Risk Factors , Mutation/genetics , Thrombophilia/complications , Thrombophilia/diagnosis , Radiography, Thoracic , Ventilation-Perfusion Ratio , Ventilation-Perfusion Ratio/physiologySubject(s)
Lung Neoplasms/diagnosis , Lymphoma, B-Cell/diagnosis , Aged, 80 and over , Female , HumansABSTRACT
Se presenta el caso de una paciente que presentó tres episodios de fiebre, infiltrados pulmonares, linfocitosis en lavado broncoalveolar y finalmente en la biopsia transbronquial mostró granulomas no caseificantes. Se estableció la relación entre la exposición al aparato de aire acondicionado de su oficina, siendo diagnosticada de neumonitis por hipersensibildad tipo fiebre de los humidificadores. Se señala la rareza de dicho cuadro, probablemente infradiagnosticado y se revisan los mecanismos patogénicos resaltando la necesidad de establecer un alto índice de sospecha
A case of a patient suffering three episodes consistent in fever, lung infiltrates, lymphocitosis in bronchoalveolar lavage and non-caseificant granulomata in transbronchial biopsy is reported. A relationship between exposition to the air conditioner in the office and the clinical picture was stablished, and the patient was finally diagnosed from humidifiers fever. We enfatize the manifestations of this uncommon disease, probably infradiagnosed, and the patogenic mechanisms are reviewed
Subject(s)
Female , Adult , Humans , Alveolitis, Extrinsic Allergic/etiology , Air Conditioning/adverse effects , Alveolitis, Extrinsic Allergic/diagnosis , Fever/etiology , Tobacco Use Disorder , Biopsy , Alveolitis, Extrinsic Allergic/pathologyABSTRACT
A case of a patient suffering three episodes consistent in fever, lung infiltrates, lymphocitosis in bronchoalveolar lavage and non-caseificant granulomata in transbronchial biopsy is reported.A relationship between exposition to the air conditioner in the office and the clinical picture was stablished, and the patient was finally diagnosed from humidifiers fever. We enfatize the manifestations of this uncommon disease, probably infradiagnosed, and the patogenic mechanisms are reviewed.
