[Tracheal intubation guided by fibrobronchoscopy in patients with difficult airway. Predictive factors of the outcome]. / Intubación traqueal guiada por fibrobroncoscopio en pacientes con vía aérea difícil. Factores predictores del resultado.

INTRODUCTION AND OBJECTIVE: Tracheal intubation (TI) guided by fibrobronchoscopy (FB) is one of the essential techniques in the approach to the difficult airway (DAW). Few works have been published on the possible causes of TI failure with this procedure. This study aims to discover which factors could predict TI failure with FB. MATERIAL AND METHODS: An observational and retrospective study in which the last 122 consecutive TIs guided by FB (between January 2000 and April 2008) performed by our group were included. A multivariate analysis of the factors that could influence in the outcome was conducted: cause of the DAW, TI pathway, type of endotracheal tube, elective or urgent indication of the procedure, sedation level and experience of the bronchoscopist. RESULTS: Tracheal intubation in individuals who are going to undergo surgical interventions accounts for 92.6% of the total. The most frequent indications of TI by FB were: limitation of neck movement (60 cases), airway stenosis (24), increase of soft tissues (13), narrow oral aperture (9), airway compression (6), and vocal cord paralysis (6). In 10 (8.2%) cases, TI by FB was not possible. The variables that best predicted IT failure in the multivariate analysis were profound sedation/ general anesthesia (OR = 12.2; 95% CI, 1.8-84; p = 0.01) and limited experience of the bronchoscopist (OR = 25.3; 95% CI, 3.5-181.8; p = 0.001). CONCLUSIONS: TI guided by FB performed by bronchoscopist is successful in more than 90% of the cases with DAW. The skill and experience of the bronchoscopist is one of the primary determining factors of success of the procedure. Profound sedation may condition TI guided by FB failure.

Intubación traqueal guiada por fibrobroncoscopio en pacientes con vía aérea difícil. Factores predictores del resultado / Tracheal intubation guided by fibrobronchoscopy in patients with difficult airway. Predictive factors of the outcome

Introducción y objetivo. La intubación traqueal (IT) guiada por fibrobroncoscopio (FB) es una de las técnicas esenciales en el abordaje de la vía aérea difícil (VAD). Hay pocos trabajos publicados sobre las causas del fallo de la IT con este procedimiento. El objetivo del presente estudio es analizar cuáles son los factores que podrían predecir el fallo de la IT con FB. Material y métodos. Estudio observacional retrospectivo en el que se incluyeron las últimas 122 IT consecutivas guiadas por FB (enero de 2000 a abril de 2008) realizadas por nuestro grupo. Se llevó a cabo un análisis multivariable de los factores que podrían influir en el resultado: causa de VAD, vía de IT, tipo de tubo endotraqueal, indicación programada o urgente del procedimiento, grado de sedación y experiencia del broncoscopista. Resultados. Las IT en individuos que se sometieron a intervenciones quirúrgicas representaron el 92,6% del total. Las indicaciones más frecuentes de la IT por FB fueron: limitación del movimiento del cuello (60 casos), estenosis de la vía aérea (24), aumento de tejidos blandos (13), apertura oral limitada (9), compresión de la vía aérea (6) y parálisis de cuerdas vocales (6). En 10 (8,2%) casos la IT por FB no fue posible. Las variables que mejor predijeron el fracaso de la IT en el análisis multivariable fueron la sedación profunda/anestesia general (odds ratio [OR] = 12,2; intervalo de confianza [IC] del 95%, 1,8-84; p = 0,01) y la escasa experiencia del broncoscopista (OR = 25,3; IC del 95%, 3,5-181,8; p = 0,001). Conclusiones. En más del 90% de los casos con VAD, la IT con FB realizada por broncoscopistas es exitosa. La habilidad y la experiencia del broncoscopista son uno de los principales determinantes del éxito del procedimiento. La sedación profunda puede condicionar el fallo de la IT por FB (AU)

Introduction and objective. Tracheal intubation (TI) guided by fibrobronchoscopy (FB) is one of the essential techniques in the approach to the difficult airway (DAW). Few works have been published on the possible causes of TI failure with this procedure. This study aims to discover which factors could predict TI failure with FB. Material and methods. An observational and retrospective study in which the last 122 consecutive TIs guided by FB (between January 2000 and April 2008) performed by our group were included. A multivariate analysis of the factors that could influence in the outcome was conducted: cause of the DAW, TI pathway, type of endotracheal tube, elective or urgent indication of the procedure, sedation level and experience of the bronchoscopist. Results. Tracheal intubation in individuals who are going to undergo surgical interventions accounts for 92.6% of the total. The most frequent indications of TI by FB were: limitation of neck movement (60 cases), airway stenosis (24), increase of soft tissues (13), narrow oral aperture (9), airway compression (6), and vocal cord paralysis (6). In 10 (8.2%) cases, TI by FB was not possible. The variables that best predicted IT failure in the multivariate analysis were profound sedation/ general anesthesia (OR = 12.2; 95% CI, 1.8-84; p = 0.01) and limited experience of the bronchoscopist (OR = 25.3; 95% CI, 3.5-181.8; p = 0.001). Conclusions. TI guided by FB performed by bronchoscopist is successful in more than 90% of the cases with DAW. The skill and experience of the bronchoscopist is one of the primary determining factors of success of the procedure. Profound sedation may condition TI guided by FB failure (AU)

The influence of risk factors on the severity of anti-tuberculosis drug-induced hepatotoxicity.

BACKGROUND: Hepatotoxicity is one of the most serious adverse effects of anti-tuberculosis drugs (ATD). Although many risk factors have been associated with ATD-induced hepatotoxicity, their influence on hepatitis severity has not been studied systematically. OBJECTIVES: To evaluate whether the presence of hepatotoxicity risk factors (advanced age, chronic liver disease, abuse of alcohol or other drugs or malnutrition) influences the severity of ATD-induced hepatotoxicity. DESIGN: A prospective cohort study of 471 active tuberculosis patients treated with isoniazid, rifampicin and pyrazinamide and followed in a tuberculosis clinic between January 1998 and July 2002. Incidence of hepatotoxicity and its severity according to the presence or absence of ATD-induced hepatitis risk factors was evaluated. RESULTS: The incidence of ATD-induced hepatotoxicity (serum transaminase > 3 x the upper limit of normal [ULN]) was 18.2% (42/231 patients) in the risk factor group and 5.8% (14/240 patients) in the non-risk factor group (OR 3.5; 95% CI 1.9-6.7; P < 0.001). Severe hepatotoxicity (transaminase > 10 x ULN) occurred in 6.9% (16/231) of the risk factor group and in 0.4% (1/240) (OR 17.7; 95% CI 2.3-135; P < 0.001) of the group without risk factors. CONCLUSIONS: ATD-induced hepatitis is significantly more frequent and more severe in patients with hepatotoxicity risk factors.

Histoplasmosis: dificultades diagnósticas en una afección marcadora de SIDA / Histoplasmosis: diagnostic difficulties in an AIDS disease

La histoplasmosis ha sido incluida como enfermedad marcadora de SIDA en 1985. En nuestro medio iguala en su incidencia a la criptococosis. Se presenta un caso de histoplasmosis diseminada subaguda con lesiones cutáneas generalizadas y estado general conservado. Se arribó a su diagnóstico luego de múltiples estudios. Fue la primera infección oportunista y la que marcó el diagnóstico de SIDA

Histoplasmosis: dificultades diagnósticas en una afección marcadora de SIDA / Histoplasmosis: diagnostic difficulties in an AIDS disease

La histoplasmosis ha sido incluida como enfermedad marcadora de SIDA en 1985. En nuestro medio iguala en su incidencia a la criptococosis. Se presenta un caso de histoplasmosis diseminada subaguda con lesiones cutáneas generalizadas y estado general conservado. Se arribó a su diagnóstico luego de múltiples estudios. Fue la primera infección oportunista y la que marcó el diagnóstico de SIDA (AU)