RESUMEN
BACKGROUND: The evidence regarding benefits of high-flow nasal cannula (HFNC) in patients with COVID-19 is controversial. The aim of this study was to evaluate the impact of HFNC in comparison with standard oxygen therapy on the frequency of endotracheal intubation at 28 d in subjects with acute hypoxemic respiratory failure (AHRF) secondary to SARS-CoV-2 infection. METHODS: A retrospective, age- and sex-matched-paired, cohort study was conducted in subjects with moderate-to-severe AHRF. Intervention group was treated with HFNC, and control group was treated with standard oxygen therapy. Baseline characteristics and clinical evolution were analyzed. Mantel-Haenszel test was used for categorical variables. Paired samples Wilcoxon test was used for quantitative variables. Multivariate analysis was performed using conditional multiple logistic regression. RESULTS: Eighty-four subjects were included. The median time from admission to progression of oxygen therapy to FIO2 ≥ 0.5 or HFNC was 1 (interquartile range [IQR] 0-3) d. PaO2 /FIO2 at the time of oxygen therapy progression showed a median of 150.5 (IQR 100.0-170.0) for the entire sample and was lower in HFNC group compared with control group (median 135 [IQR 96-162] vs median 158 [IQR 132-174], respectively, P = .02). Endotracheal intubation at 28 d was observed in 54.8% HFNC and 73.8% standard oxygen (unadjusted odds ratio 0.38 [95% CI 0.13-1.07], P = .069). In the multivariate analysis, presence of dyspnea at hospital admission, Sequential Organ Failure Assessment score, and PaO2 /FIO2 at time of progression of oxygen therapy to FIO2 ≥ 0.5 was identified as confounding factors for the association between the intervention group and the outcome. Use of HFNC was not an independent predictor of endotracheal intubation frequency after adjusting confounders (odds ratio 0.26 [95% CI 0.04-1.51], P = .13). CONCLUSIONS: In this study, HFNC therapy in subjects with AHRF secondary to COVID-19 was not an independent predictor of endotracheal intubation, compared with standard oxygen therapy, after adjusting for confounders.
RESUMEN
RESUMEN Objetivo: Describir la etiología más frecuente en sujetos que requirieron cirugía por artroplastía fallida de cadera en sala de Ortopedia y Traumatología (OyT) del Hospital General de Agudos "Dr. Juan A. Fernández" (HGAJAF) entre julio de 2018 y noviembre de 2019. Materiales y método: Estudio descriptivo, observacional y transversal, de carácter retrospectivo a partir de una base de datos de la sala de OyT creada por el Servicio de Kinesiología del HGAJAF. El tipo de muestreo fue no probabilístico y consecutivo. Se incluyeron sujetos de ambos sexos, mayores de 18 años, internados en sala de OyT del HGAJAF en el período comprendido entre julio de 2018 y noviembre de 2019, con diagnóstico médico de artroplastía total de cadera, y que fueron intervenidos quirúrgicamente por falla en su reemplazo primario en este nosocomio o en otro establecimiento. Se excluyeron sujetos cuya historia clínica se encontraba incompleta por falta o pérdida de datos demográficos de los mismos y aquellos que fueron sometidos a una cirugía de resección. Resultados: Se reclutaron un total de 48 sujetos. El aflojamiento séptico ocurrió en 20 de ellos (41,6%) y se presentó como causa de falla más prevalente, seguido por el aflojamiento aséptico en 16 sujetos (33,3%). Conclusión: En esta muestra de sujetos con artroplastia fallida, el motivo de falla más frecuente fue el aflojamiento séptico.
ABSTRACT Objective: To describe the most frequent etiology in subjects who required surgery due to failure of hip arthroplasty in the orthopaedics and traumatology ward of Hospital General de Agudos Dr. Juan A. Fernández (HGAJAF) between July 2018 and November 2019. Materials and Method: A descriptive, observational, retrospective, and cross-sectional study. It was based on a database created by the HGAJAF physiotherapy service. A non-probability and consecutive sampling method was performed. We included over 18-year-old subjects who were hospitalized in the HGAJAF trauma ward between July 2018 and November 2019 and were diagnosed with a total hip arthroplasty, and who underwent surgery due to replacement failure in this hospital or elsewhere. Subjects with incomplete medical records due to lack or loss of demographic data and subjects who underwent resection surgery were excluded. Results: A total of 48 subjects were recruited. The most prevalent cause of failure was septic loosening n=20 (41.67%), followed by aseptic loosening n=16 (33.3%). Conclusion: The most frequent reason for failure in this sample of subjects with failed arthroplasty was septic loosening.