Efectividad del suero salino hipertónico nebulizado en pacientes con hipersecreción bronquial / Effectiveness of nebulized hypertonic saline in patients with bronchial hypersecretion

Introducción: El suero salino hipertónico (SSH) nebulizado mejora la calidad de vida y reduce las exacerbaciones en pacientes con fibrosis quística. Se desconoce si ofrecería los mismos beneficios en otras patologías hipersecretoras.MétodosEstudio observacional retrospectivo. Se incluyeron pacientes que superaron la prueba de tolerancia e iniciaron SSH al 5,8% con un año de seguimiento. Se cuantificaron parámetros clínicos y asistenciales en los años previo y posterior al inicio del tratamiento.ResultadosUn total de 101 pacientes, 60,4% mujeres, media de edad 65años (IC95%: 62,4-67,9): 82 (81,2%) bronquiectasias, 6 (5,9%) EPOC, 2 (2%) asma, 1 (1%) EPID y 10 (9,9%) otros. Se evidenció una reducción de la broncorrea (91,1% vs 75,2%), de las infecciones de repetición (57,4% vs 22,8%) y de los ciclos de antibioterapia (1,54 vs 0,55), así como un aumento del FEV1 (1.881ml vs 1.942ml) y una disminución de las asistencias a atención primaria (2,94 vs 1,1), de urgencias (0,36 vs 0,17) y de hospitalizaciones (0,17 vs 0,06). Setenta y tres pacientes (72,3%) presentaron una adecuada tolerancia.ConclusiónLa nebulización de SSH al 5,8% en pacientes con hipersecreción bronquial es segura y tiene un destacable impacto clínico y asistencial. (AU)

Introduction: Nebulized hypertonic saline (HS) improves quality of life and reduces exacerbations in patients with cystic fibrosis. It is unknown if it would offer the same benefits in other hypersecretory pathologies.MethodsRetrospective observational study. Patients who passed the tolerance test and started HS 5.8% with one year of follow-up were included. Clinical and healthcare parameters were quantified in the year before and after the start of treatment.Results101 patients, 60.4% women, 65years (95%CI: 62.4-67.9): 82 (81.2%) bronchiectasis, 6 (5.9%) COPD, 2 (2%) asthma, 1 (1%) ILD, and 10 (9.9%) other causes. There was a reduction in bronchorrhea (91.1% vs 75.2%), recurrent infections (57.4% vs 22.8%) and cycles of antibiotic therapy (1.54 vs 0.55), as well as an increase in FEV1 (1881ml vs. 1942ml) and a decrease in visits to primary care (2.94 vs. 1.1), emergencies (0.36 vs. 0.17) and hospitalizations (0.17 vs. 0.17). 06). 73 patients (72.3%) presented an adequate tolerance.ConclusionNebulization of HS 5.8% in patients with bronchial hypersecretion is safe and has a remarkable clinical and healthcare impact. (AU)

[Effectiveness of nebulized hypertonic saline in patients with bronchial hypersecretion]. / Efectividad del suero salino hipertónico nebulizado en pacientes con hipersecreción bronquial.

INTRODUCTION: Nebulized hypertonic saline (HS) improves quality of life and reduces exacerbations in patients with cystic fibrosis. It is unknown if it would offer the same benefits in other hypersecretory pathologies. METHODS: Retrospective observational study. Patients who passed the tolerance test and started HS 5.8% with one year of follow-up were included. Clinical and healthcare parameters were quantified in the year before and after the start of treatment. RESULTS: 101 patients, 60.4% women, 65years (95%CI: 62.4-67.9): 82 (81.2%) bronchiectasis, 6 (5.9%) COPD, 2 (2%) asthma, 1 (1%) ILD, and 10 (9.9%) other causes. There was a reduction in bronchorrhea (91.1% vs 75.2%), recurrent infections (57.4% vs 22.8%) and cycles of antibiotic therapy (1.54 vs 0.55), as well as an increase in FEV1 (1881ml vs. 1942ml) and a decrease in visits to primary care (2.94 vs. 1.1), emergencies (0.36 vs. 0.17) and hospitalizations (0.17 vs. 0.17). 06). 73 patients (72.3%) presented an adequate tolerance. CONCLUSION: Nebulization of HS 5.8% in patients with bronchial hypersecretion is safe and has a remarkable clinical and healthcare impact.

Meta-analysis of the effects of normal saline on mortality in intensive care. / Metaanálisis de los efectos del suero salino en la mortalidad en cuidados intensivos.

INTRODUCTION AND OBJECTIVE: To evaluate, by means of a meta-analysis, the effect of normal saline on mortality in intensive care patients, when compared with the use of balanced crystalloids. MATERIAL AND METHOD: Published controlled clinical trials, randomised and sequential prospective studies in time, evaluating the mortality when physiological saline was used in patients admitted to intensive care units. Electronic search was performed in Medline, Embase, Cochrane Library, ISI Proceedings, and Web of Science, as well as a manual search of selected references. An independent evaluation was performed by 2 investigators. Discrepancies were resolved by consensus in the working group. Contingency tables were performed, and the OR with confidence intervals of each study were obtained. Heterogeneity was assessed by I2. Publication bias was assessed using funnel plot and Egger test. RESULTS: A total of 8 articles were selected for the meta-analysis of mortality, which included a total of 20,684 patients. A significant association was observed between the use of saline and mortality in intensive care patients (OR 1.0972; 95% CI 1.0049-1.1979), when compared to the use of balanced crystalloids. No statistical evidence of publication bias (Egger, P=.5349) was found. In the sensitivity analysis, none of the studies substantially modified the overall outcome if it was eliminated from the meta-analysis. CONCLUSIONS: There may be an increase in mortality associated with the use of saline in patients admitted to intensive care when comparing with the use of balanced crystalloids.

Choice of fluids in the perioperative period of kidney transplantation. / Elección de fluidos en el periodo perioperatorio del trasplante renal.

Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However, the problems arising from hyperchloraemia triggered by the infusion of normal saline have led to studies being conducted that compare this solution with balanced solutions. From this narrative review it can be concluded that the use of balanced crystalloids containing potassium in the perioperative period of kidney transplantation can be considered safe. These solutions do not affect serum potassium levels any more than normal saline, whilst maintaining a better acid-base balance in these patients.

A Comparison of the Effect of Chlorhexidine, Tap Water and Normal Saline on Healing Wounds / Comparación del Efecto de Clorhexidina, Agua Corriente y Suero Salino en Curación de Heridas

Many researchers have advocated in recent times that antiseptic use in healing wounds should be discouraged. Antiseptics have been found to retard healing of wounds. Innocuous solutions like normal saline and tap water are being considered as better alternatives to antiseptics. Chlorhexidine, a commonly used antiseptic, is known to be less toxic on granulation cells. We decided to compare the effect of chlorhexidine, normal saline and tap water on healing wounds. Three groups of wistar rats had 2 by 2cm full thickness wounds made on their right dorsolateral flanks. The wounds were dressed with either chlorhexidine, normal saline or tap water. Wounds were examined at three-day intervals and measurements of area covered were taken on the first day of study and the ninth day. Wound contraction on the ninth day and number of days for healing to take place in the different groups was taken and statistical analysis using student t-test was done to compare the values. Gross morphology of the wounds was also observed. The result showed an inhibitory effect of chlorhexidine on healing wounds. The wound contraction in the antiseptic group was less than the tap water and saline group on day nine. The average number of days for wound healing to be completed in the antiseptic group was more than the other two. These results were statistically significant when compared with the other two groups. There was no statistical difference in the wound contraction values and rate of healing of the saline and tap water dressed wounds. Grossly, all the wounds dressed with antiseptic also had greenish exudates on their surface by day nine with pale looking granulation tissue, and there was greater mortality in this group.

En la actualidad, diversos investigadores han propagado que el uso de antisépticos en heridas en cicatrización debería, ser abandonado. Se ha encontrado que los antisépticos retardan la cicatrización. Soluciones inocuas, tales como, suero salino y agua corriente, están siendo consideradas como mejores alternativas para efectos antisépticos. La clorhexidina, un antiséptico comúnmente usado, es conocida por ser menos tóxica sobre las células granulares. Basado en lo anterior, comparamos los efectos de la clorhexidina, suero salino y agua corriente en heridas en cicatrización. A tres grupos de ratas Wistar se les infirió heridas de 2 x 2 cm de grosor, en su flanco dorsolateral derecho. La heridas fueron cubiertas (pinceladas) con clorhexidina, solución salina o agua corriente, según el caso. Estas heridas fueronn examinadas cada tres días y las mediciones del área cubierta fueron registradas desde el primero al noveno día. La contracción de la herida al noveno día y el número de días que llevó para cicatrizar se regsitraron en los diversos grupos, analizando los resultados esatadísticamente, usando el test t- student para comparar los valores. La morfología macroscópica también fue observada. Los resultados mostraron un efecto inhibidor de la clorhexidina sobre la cicatrización. La contracción de la herida en el grupo con antiséptico fue menor que en los grupos con suero salino y agua corriente. El promedio de días para cicatrizar, fue mayor en el grupo con antiséptico. Estos resultados fueron estadísticamente significativos al compararlos con los otros dos grupos. No hubo diferencias estadísticamente significativas en los valores de contracción de la herida y rango de cicatrización en el grupo tratado con suero salino normal y en el con agua corriente. Desde el punto de vista macroscópico, las heridas tratadas con el antiséptico también tuvieron un exudado verdoso sobre su superficie al día noveno con un tejido granular pálido y hubo mayor ...