Adaptation and follow-up to noninvasive home mechanical ventilation: ambulatory versus hospital.

BACKGROUND AND OBJECTIVES: Noninvasive home mechanical ventilation (HMV) has been shown to be beneficial for certain forms of respiratory failure, improving symptoms and quality of life. Adaptation and follow-up are usually conducted within the hospital framework. Our objective was to verify whether the same results could be obtained in the patient's home by the Home Hospitalization Unit. METHODS: This was a prospective study of patients with stable restrictive ventilatory disorders, who met the criteria to receive HMV. They underwent hospital adaptation (group 1) or ambulatory adaptation (group 2) based on geographical area. The following tests were performed throughout the follow-up: Borg scale, respiratory function, arterial blood gases, nocturnal pulse oximetry, a health survey questionnaire (SF-36), and initially, the Barthel index. Adaptation and follow-up were performed identically in both groups in accordance with the adaptation and follow-up protocol of our hospital. Independent and intergroup comparisons were made for both groups. RESULTS: Forty-two patients (21 at hospital and 21 at home) were included. No initial differences were found between the two groups. Improvements were noted on the Borg scale and for nocturnal pulse oximetry within the groups, with no differences between them. No improvement in pulmonary function was observed in either group. Arterial blood gases improved in both groups, but the ambulatory group recorded significantly higher values (PO(2), P=0.033; PCO(2), P=0.020). Most domains of the SF-36 questionnaire improved in both groups, although some intergroup differences were noted. CONCLUSIONS: HMV improved arterial blood gases and quality of life in patients with restrictive ventilatory disorders. Arterial blood gases were better in the ambulatory group and the quality of life was similar in both groups.

[Legionnaire's disease outbreak]. / Estudio de un brote de infección por Legionella pneumophila.

BACKGROUND AND OBJECTIVE: To describe an outbreak of Legionella pneumophila serogroup 1 in Mataró, Catalunya, Spain, in August 2002. The source of the microorganism was a cooling tower. PATIENTS AND METHOD: Prospective and observational study with analysis of epidemiological, clinical, and microbiological data. RESULTS: 151 patients were affected (62% male), with a mean age of 58.4 years old. Seven patients were classified as Pontiac Fever and 144 suffered from pneumonia. The diagnosis of pneumonia was confirmed in 79% of cases, was considered suspicious in 14% and probable in 7%. Forty per cent of patients were smokers and 53.5% had comorbidities, mainly diabetes mellitus (22%). Chief symptoms were fever (97%), chills and muscular pain (63% respectively), headache (54%) and cough (53%). Pulmonary condensation was the more frequent radiological feature (71%). Normal pulmonary exploration was observed in 38%. Forty-three per cent of cases were severely ill, and 16% of patients belonged to Fine's IV and V class. Antigenuria was the most important test for diagnosis, which confirmed 76% of cases. Legionella spp. was obtained in respiratory secretions of 10 patients. Molecular analysis confirmed clonality between respiratory microorganisms and that obtained in the cooling tower. CONCLUSION: The outbreak involved an important number of subjects in a short period of time. Antigenuria was the most useful test. However, the isolation of L. pneumophila from patients permitted the prompt identification of microorganism's source in a cooling tower. The low mortality observed probably relates to a rapid diagnosis and its target treatment.

Estudio de un brote de infección por Legionella pneumophila / Legionnaire's disease outbreak

Fundamento y objetivo: Describir un brote comunitario de neumonía por Legionella pneumophila serogrupo 1 ocurrido en la ciudad de Mataró en agosto de 2002, cuyo origen fue una torre de refrigeración. Pacientes y método: Estudio observacional y prospectivo. Se analizan aspectos epidemiológicos, factores de riesgo, hallazgos clínicos, radiológicos y microbiológicos. Resultados: El brote de infección afectó a 151 pacientes: un 62% eran varones y la edad media fue de 58,4 años. Se diagnosticó a 7 de fiebre de Pontiac y a 144 casos de neumonía (un 79% confirmadas, un 14% sospechosas y un 7% probables). Un 40% de los pacientes eran fumadores, un 53,5% tenía alguna enfermedad subyacente y un 22% eran diabéticos. Los síntomas predominantes fueron fiebre (97%), escalofríos y mialgias (ambos en el 63%), cefalea (54%) y tos (53%). La imagen radiológica más frecuente fue la condensación unilobular (71%). La semiología respiratoria fue normal en el 38%. Un 43% de los pacientes tenían criterios clínicos de gravedad. Un 16% se clasificó en los grupos IV-V de Fine. El diagnóstico se efectuó por antigenuria en el 76%; 10 pacientes tenían cultivo de muestras respiratorias positivo. El estudio molecular mostró coincidencia entre las cepas de las muestras clínicas y las de la torre de refrigeración. El tratamiento en el 95,6% de los casos fue con claritromicina. La mortalidad fue del 1,4%. Conclusiones: El brote de infección por L. pneumophila afectó a muchas personas en un período muy breve. La prueba diagnóstica más útil fue la antigenuria. El aislamiento de Legionella en muestras respiratorias fue fundamental para establecer la fuente de la infección. La baja mortalidad está relacionada probablemente con la rapidez del diagnóstico y el tratamiento adecuado

Background and objective: To describe an outbreak of Legionella pneumophila serogroup 1 in Mataró, Catalunya, Spain, in August 2002. The source of the microorganism was a cooling tower. Patients and method: Prospective and observational study with analysis of epidemiological, clinical, and microbiological data. Results: 151 patients were affected (62% male), with a mean age of 58.4 years old. Seven patients were classified as Pontiac Fever and 144 suffered from pneumonia. The diagnosis of pneumonia was confirmed in 79% of cases, was considered suspicious in 14% and probable in 7%. Forty per cent of patients were smokers and 53.5% had comorbidities, mainly diabetes mellitus (22%). Chief symptoms were fever (97%), chills and muscular pain (63% respectively), headache (54%) and cough (53%). Pulmonary condensation was the more frequent radiological feature (71%). Normal pulmonary exploration was observed in 38%. Forty-three per cent of cases were severely ill, and 16% of petients belonged to Fine's IV or V class. Antigenuria was the most important test for diagnosis, which confirmed 76% of cases. Legionella spp. was obtained in respiratory secretions of 10 patients. Molecular analysis confirmed clonality between respiratory microorganisms and that obtained in the cooling tower. Conclusion: The outbreak involved an important number of subjects in a short period of time. Antigenuria was the most useful test. However, the isolation of L. pneumophila from patients permitted the prompt identification of microorganism's source in a cooling tower. The low mortality observed probably relates to a rapid diagnosis and its target treatment