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1.
Eur Respir J ; 50(1)2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28679605

RESUMO

We assessed whether prolongation of nocturnal noninvasive ventilation (NIV) after recovery from acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) patients with NIV could prevent subsequent relapse of AHRF.A randomised controlled trial was performed in 120 COPD patients without previous domiciliary ventilation, admitted for AHRF and treated with NIV. When the episode was resolved and patients tolerated unassisted breathing for 4 h, they were randomly allocated to receive three additional nights of NIV (n=61) or direct NIV discontinuation (n=59). The primary outcome was relapse of AHRF within 8 days after NIV discontinuation.Except for a shorter median (interquartile range) intermediate respiratory care unit (IRCU) stay in the direct discontinuation group (4 (2-6) versus 5 (4-7) days, p=0.036), no differences were observed in relapse of AHRF after NIV discontinuation (10 (17%) versus 8 (13%) for the direct discontinuation and nocturnal NIV groups, respectively, p=0.56), long-term ventilator dependence, hospital stay, and 6-month hospital readmission or survival.Prolongation of nocturnal NIV after recovery from an AHRF episode does not prevent subsequent relapse of AHRF in COPD patients without previous domiciliary ventilation, and results in longer IRCU stay. Consequently, NIV can be directly discontinued when the episode is resolved and patients tolerate unassisted breathing.


Assuntos
Tempo de Internação/estatística & dados numéricos , Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Respiratória/terapia , Idoso , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Recidiva , Espanha , Fatores de Tempo
2.
Crit Care Med ; 40(8): 2385-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22622402

RESUMO

OBJECTIVE: To evaluate the effects of systemic treatment with linezolid compared with vancomycin on biofilm formation in mechanically ventilated pigs with severe methicillin-resistant Staphylococcus aureus-induced pneumonia. DESIGN: Prospective randomized animal study. SETTING: Departments of Pneumology, Microbiology, and Pharmacy of the Hospital Clínic, Barcelona, and Scientific and Technological Services of the University of Barcelona. SUBJECTS: We prospectively analyzed 70 endotracheal tube samples. Endotracheal tubes were obtained from pigs either untreated (controls, n=20), or treated with vancomycin (n=32) or linezolid (n=18). INTERVENTIONS: The endotracheal tubes were obtained from a previous randomized study in tracheally intubated pigs with methicillin-resistant Staphylococcus aureus severe pneumonia, and mechanically ventilated for 69±16 hrs. MEASUREMENTS AND MAIN RESULTS: Distal and medial hemisections of the endotracheal tube were assessed to quantify methicillin-resistant Staphylococcus aureus burden, antibiotic biofilm concentration by high-performance liquid chromatography or bioassay, and biofilm thickness through scanning electron microscopy. We found a trend toward a significant variation in biofilm methicillin-resistant Staphylococcus aureus burden (log colony-forming unit/mL) among groups (p=.057), and the lowest bacterial burden was found in endotracheal tubes treated with linezolid (1.98±1.68) in comparison with untreated endotracheal tubes (3.72±2.20, p=.045) or those treated with vancomycin (2.97±2.43, p=.286). Biofilm linezolid concentration was 19-fold above the linezolid minimum inhibitory concentration, whereas biofilm vancomycin concentration (1.60±0.91 µg/mL) was consistently below or close to the vancomycin minimum inhibitory concentration. Biofilm was thicker in the vancomycin group (p=.077). CONCLUSIONS: Systemic treatment with linezolid limits endotracheal tube biofilm development and methicillin-resistant Staphylococcus aureus burden. The potential clinical usefulness of linezolid in decreasing the risk of biofilm-related respiratory infections during prolonged tracheal intubation requires further investigation.


Assuntos
Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Biofilmes/efeitos dos fármacos , Intubação Intratraqueal/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Oxazolidinonas/uso terapêutico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Animais , Linezolida , Microscopia Eletrônica de Varredura , Pneumonia Estafilocócica/tratamento farmacológico , Suínos , Vancomicina/uso terapêutico
3.
FEMS Immunol Med Microbiol ; 65(2): 309-17, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22444646

RESUMO

Confocal laser scanning microscopy (CLSM) helps to observe the biofilms formed in the endotracheal tube (ETT) of ventilated subjects and to determine its structure and bacterial viability using specific dyes. We compared the effect of three different treatments (placebo, linezolid, and vancomycin) on the bacterial biofilm viability captured by CLSM. Eight pigs with pneumonia induced by methicillin-resistant Staphylococcus aureus (MRSA) were ventilated up to 96 h and treated with linezolid, vancomycin, or placebo (controls). ETT images were microscopically examined after staining with the live/dead(®) BacLight(™) Kit (Invitrogen, Barcelona, Spain) with a confocal laser scanning microscope. We analyzed 127 images obtained by CLSM. The median ratio of live/dead bacteria was 0.51, 0.74, and 1 for the linezolid, vancomycin, and control groups, respectively (P = 0.002 for the three groups); this ratio was significantly lower for the linezolid group, compared with the control group (P = 0.001). Images showed bacterial biofilm attached and non-attached to the ETT surface but growing within secretions accumulated inside ETT. Systemic treatment with linezolid is associated with a higher proportion of dead bacteria in the ETT biofilm of animals with MRSA pneumonia. Biofilm clusters not necessarily attach to the ETT surface.


Assuntos
Antibacterianos/administração & dosagem , Biofilmes/crescimento & desenvolvimento , Equipamentos e Provisões/microbiologia , Intubação Intratraqueal , Staphylococcus aureus Resistente à Meticilina/fisiologia , Viabilidade Microbiana/efeitos dos fármacos , Pneumonia Estafilocócica/microbiologia , Acetamidas/administração & dosagem , Animais , Biofilmes/efeitos dos fármacos , Modelos Animais de Doenças , Linezolida , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Microscopia Confocal , Oxazolidinonas/administração & dosagem , Placebos/administração & dosagem , Pneumonia Estafilocócica/tratamento farmacológico , Espanha , Coloração e Rotulagem/métodos , Suínos , Vancomicina/administração & dosagem
4.
Crit Care Med ; 40(1): 162-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21926613

RESUMO

OBJECTIVE: To assess the efficacy of linezolid compared with vancomycin in an experimental model of pneumonia induced by methicillin-resistant Staphylococcus aureus (MRSA) in ventilated pigs. METHODS: Forty pigs (30 kg) were intubated and challenged via bronchoscopy with a suspension of 106 colony forming units of MRSA into every lobe. Afterwards, pigs were ventilated up to 96 hours. Twelve hours after bacterial inoculation, the animals were randomized into 4 groups of treatment: group 1, control; group 2, vancomycin twice daily; group 3, continuous infusion of vancomycin; and group 4, linezolid. Clinical and laboratory parameters were monitored throughout the study. Bacterial cultures of bronchoalveolar lavage fluid and lung tissue samples were performed at the end of the study. Measurements of histopathology derangements of lung samples and studies of intrapulmonary drug penetration were performed. RESULTS: A total of 34 animals completed the study. No differences in clinical and laboratory parameters were observed. The percentage of bronchoalveolar lavage fluid and lung tissue samples with positive cultures for MRSA in controls and groups 2, 3, and 4 was respectively 75%, 11%, 11%, and 0% (p < .01); 52%, 9%, 24%, and 2.5% (p < .01). Histopathology studies demonstrated signs of pneumonia in 95%, 69%, 58%, and 57% and signs of severe pneumonia in 48%, 29%, 22%, and 0% of controls and groups 2, 3, and 4, respectively (p < .01). In addition, pharmacokinetics/pharmacodynamics profile in serum and lung tissue showed better results for linezolid compared with both vancomycin treatments. CONCLUSIONS: In this animal model of MRSA pneumonia, linezolid showed a better efficacy than vancomycin showed because of a better pharmacokinetics/pharmacodynamics index.


Assuntos
Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Vancomicina/uso terapêutico , Animais , Líquido da Lavagem Broncoalveolar/química , Modelos Animais de Doenças , Interleucina-6/análise , Interleucina-6/sangue , Interleucina-8/análise , Interleucina-8/sangue , Linezolida , Pulmão/patologia , Pneumonia Estafilocócica/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Respiração Artificial/efeitos adversos , Suínos , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/sangue
5.
Arch. bronconeumol. (Ed. impr.) ; 47(3): 122-127, mar. 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-88484

RESUMO

ObjetivoAnalizar el significado de la presencia de linfocitos en las muestras de punción transbronquial aspirativa (PTA) de adenopatías mediastínicas (AM) en pacientes con sospecha de cáncer de pulmón (CP).MétodosEstudio observacional retrospectivo que evalúa el valor predictivo negativo (VPN) de las muestras de PTA con evidencia de linfocitos pero sin células atípicas.ResultadosSe realizaron 266 PTA a 252 pacientes con AM patológicas. En 115 PTA se evidenció la presencia de metástasis ganglionares (43%), y 94 (35%) fueron consideradas como no valorables (ausencia de material citológico evaluable o presencia exclusiva de células epiteliales bronquiales). De las 57 muestras de PTA restantes que contenían linfocitos sin atipias (21%), en 15 no se pudo confirmar el diagnóstico; en 32 se confirmó mediante técnicas diagnósticas alternativas y en 10 mediante seguimiento clínico-radiológico. El VPN de las 32 muestras confirmadas con técnicas diagnósticas alternativas fue del 84% y descendió al 76% cuando se incluyeron las 10 PTA en las que se disponía de seguimiento clínico-radiológico.ConclusionesLa presencia de linfocitos sin atipias en la muestra de PTA no excluye la invasión neoplásica del ganglio analizado(AU)


AimTo evaluate the clinical relevance of the presence of lymphocytes in transbronchial needle aspiration (TBNA) samples from pathological mediastinal lymph nodes in patients with suspected lung cancer.MethodsRetrospective observational study evaluating the negative predictive value (NPV) of TBNA samples containing lymphocytes but not malignant cells.ResultsA total of 266 TBNA were performed in 252 patients with pathological lymph nodes. One hundred and fifteen TBNA samples had evidence of malignant cells (43%), and 94 (35%) samples were considered as inadequate (absence of adequate cytological material or exclusive presence of bronchial epithelial cells). Out of the 57 TBNA samples remaining (21%), 15 could not be confirmed; in 32, TBNA samples were confirmed with alternative diagnostic techniques and in 10, they were confirmed after clinical and radiological follow-up. The NPV of the 32 samples that were confirmed with alternative diagnostic techniques was 84% decreasing down to 76% when the 10 TBNA samples confirmed after clinical and radiological follow-up were included.ConclusionsThe presence of lymphocytes in the TBNA sample does not exclude the neoplasic invasion of the specific lymph node analyzed(AU)


Assuntos
Humanos , Linfócitos/citologia , Neoplasias Pulmonares/patologia , Biópsia por Agulha , Valor Preditivo dos Testes , Estudos Retrospectivos , Neoplasias do Mediastino/patologia , Metástase Linfática/patologia
6.
Arch Bronconeumol ; 47(3): 122-7, 2011 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-21277665

RESUMO

AIM: To evaluate the clinical relevance of the presence of lymphocytes in transbronchial needle aspiration (TBNA) samples from pathological mediastinal lymph nodes in patients with suspected lung cancer. METHODS: Retrospective observational study evaluating the negative predictive value (NPV) of TBNA samples containing lymphocytes but not malignant cells. RESULTS: A total of 266 TBNA were performed in 252 patients with pathological lymph nodes. One hundred and fifteen TBNA samples had evidence of malignant cells (43%), and 94 (35%) samples were considered as inadequate (absence of adequate cytological material or exclusive presence of bronchial epithelial cells). Out of the 57 TBNA samples remaining (21%), 15 could not be confirmed; in 32, TBNA samples were confirmed with alternative diagnostic techniques and in 10, they were confirmed after clinical and radiological follow-up. The NPV of the 32 samples that were confirmed with alternative diagnostic techniques was 84% decreasing down to 76% when the 10 TBNA samples confirmed after clinical and radiological follow-up were included. CONCLUSIONS: The presence of lymphocytes in the TBNA sample does not exclude the neoplasic invasion of the specific lymph node analyzed.


Assuntos
Biópsia por Agulha/métodos , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma de Células Pequenas/secundário , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Metástase Linfática/patologia , Contagem de Linfócitos , Linfócitos/patologia , Melanoma/secundário , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Idoso , Idoso de 80 Anos ou mais , Brônquios , Broncoscopia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Neoplasias do Colo/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Metástase Linfática/diagnóstico por imagem , Masculino , Mediastino , Melanoma/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Estudos Retrospectivos , Método Simples-Cego , Neoplasias Cutâneas/patologia
7.
Clin Chem Lab Med ; 48(3): 391-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20113250

RESUMO

BACKGROUND: Linezolid is the first synthetic compound of a new group of antimicrobials, the oxazolidinones, which inhibit protein synthesis. It shows a broad spectrum of activity against Gram positive organisms. With respect to its pharmacokinetics, linezolid shows a relatively high volume of distribution and good penetration into inflammatory fluids, bone, fat and muscle. METHODS: A reversed-phase isocratic high-performance liquid chromatographic method for linezolid analysis in piglet pulmonary tissue is described. Tissue samples and controls were prepared in 1 x TBE (1 M Tris, 0.9 M boric acid, 0.01 M EDTA). The mobile phase consisted of 20% ultrafiltered water and 80% of (A) 15 mM potassium monohydrogen phosphate buffer (pH = 5) with (B) acetonitrile (80%/20%; v/v). Samples were homogenized and precipitated with HClO(4) 3% (1/1, v/v). The injection volume was 100 microL. Ofloxacin was used as an internal standard. RESULTS: The assay was linear over a linezolid concentration range: 1.6-100 microg/mL. The method provided good validation data (n = 15): inaccuracy (3.6%), intra and inter-day variability (4.2% and 5.2%, respectively), recovery (91.8%), limit of detection (0.8 microg/mL) and quantitation (1.6 microg/mL) and acceptable stability within 24 h in the auto-sampler. CONCLUSIONS: The method offers a fast and simple approach to determine linezolid in pulmonary tissue which could be of use in pharmacokinetic studies.


Assuntos
Acetamidas/análise , Anti-Infecciosos/análise , Cromatografia Líquida de Alta Pressão/métodos , Pulmão/química , Oxazolidinonas/análise , Acetamidas/farmacocinética , Animais , Anti-Infecciosos/farmacocinética , Calibragem , Cromatografia Líquida de Alta Pressão/normas , Estabilidade de Medicamentos , Limite de Detecção , Linezolida , Oxazolidinonas/farmacocinética , Reprodutibilidade dos Testes , Suínos
8.
Arch Bronconeumol ; 44(6): 290-4, 2008 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-18559217

RESUMO

OBJECTIVE: The role of different techniques for mediastinal staging in patients with suspected lung cancer is a subject of debate. The aim of this study was to analyze the diagnostic yield and cost-effectiveness of transbronchial needle aspiration in the mediastinal staging of lung cancer in patients being evaluated in a tertiary hospital. PATIENTS AND METHODS: This was a retrospective, observational study of the results of transbronchial needle aspiration in patients with suspected lung cancer and mediastinal lymph node involvement. A cost-effectiveness analysis of the systematic use of this technique was also performed. RESULTS: One-hundred ninety-four patients (85% men, 15% women) were evaluated. The diagnosis of lung cancer was confirmed in 157 (81%). Cytology samples obtained by transbronchial needle aspiration were adequate in 147 (76%) of the 194 cases. When only the adequate samples were included in the analysis, transbronchial needle aspiration showed a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, negative predictive value of 64%, and efficiency of 90%. Mediastinoscopy was avoided in 44 (34%) of the 127 patients with localized non-small cell lung cancer, with an estimated saving of euro 119,456. CONCLUSIONS: Transbronchial needle aspiration has a high diagnostic yield and obviates the need for mediastinoscopy in a significant percentage of cases. This finding is of diagnostic and economic significance.


Assuntos
Biópsia por Agulha/economia , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Biópsia por Agulha/métodos , Brônquios , Análise Custo-Benefício , Feminino , Humanos , Metástase Linfática , Masculino , Mediastino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Arch. bronconeumol. (Ed. impr.) ; 44(6): 290-294, jun. 2008. tab
Artigo em Es | IBECS | ID: ibc-65358

RESUMO

OBJETIVO: Existe controversia sobre el papel de las diferentes técnicas diagnósticas en la estadificación del mediastino en pacientes con sospecha de cáncer de pulmón. El objetivo del estudio ha sido analizar la rentabilidad diagnóstica y el coste-beneficio de la punción transbronquial aspirativa (PTA) en la estadificación mediastínica del cáncer de pulmón, en pacientes evaluados en un hospital de tercer nivel. PACIENTES Y MÉTODOS: Se ha realizado un estudio observacional retrospectivo, en el que se han analizado los resultados de las PTA practicadas a pacientes con sospecha de cáncer de pulmón y adenopatías mediastínicas patológicas. También se ha evaluado el coste-beneficio de la aplicación sistemática de esta técnica. RESULTADOS: Se evaluó a 194 pacientes (un 85% varones y un 15% mujeres), en 157 de los cuales (81%) se confirmó el diagnóstico de cáncer de pulmón. La muestra citológica que se obtuvo de la PTA fue adecuada en 147 de los 194 casos (76%). Cuando se analizaron las muestras adecuadas, la sensibilidad de la PTA fue del 88%, la especificidad del 100%, el valor predictivo positivo del 100%, el valor predictivo negativo del 64% y el valor global del 90%. En 44 de los 127 casos (34%) con cáncer de pulmón no microcítico localizado se evitó la realización de una mediastinoscopia, lo que representó un ahorro económico estimado de 119.456 ¿. CONCLUSIONES: La PTA es una técnica con una elevada rentabilidad diagnóstica que puede evitar la realización de una mediastinoscopia en un porcentaje significativo de pacientes, con las consiguientes implicaciones terapéuticas y económicas que ello conlleva


OBJECTIVE: The role of different techniques for mediastinal staging in patients with suspected lung cancer is a subject of debate. The aim of this study was to analyze the diagnostic yield and cost-effectiveness of transbronchial needle aspiration in the mediastinal staging of lung cancer in patients being evaluated in a tertiary hospital. PATIENTS AND METHODS: This was a retrospective, observational study of the results of transbronchial needle aspiration in patients with suspected lung cancer and mediastinal lymph node involvement. A cost-effectiveness analysis of the systematic use of this technique was also performed. RESULTS: One-hundred ninety-four patients (85% men, 15% women) were evaluated. The diagnosis of lung cancer was confirmed in 157 (81%). Cytology samples obtained by transbronchial needle aspiration were adequate in 147 (76%) of the 194 cases. When only the adequate samples were included in the analysis, transbronchial needle aspiration showed a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, negative predictive value of 64%, and efficiency of 90%. Mediastinoscopy was avoided in 44 (34%) of the 127 patients with localized non-small cell lung cancer, with an estimated saving of ¿119 456. CONCLUSIONS: Transbronchial needle aspiration has a high diagnostic yield and obviates the need for mediastinoscopy in a significant percentage of cases. This finding is of diagnostic and economic significance


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Biópsia por Agulha , Doenças do Mediastino/diagnóstico , Estadiamento de Neoplasias/métodos , Valor Preditivo dos Testes , Mediastinoscopia , Broncoscopia/métodos , Sensibilidade e Especificidade , Análise Custo-Benefício/estatística & dados numéricos , Análise Custo-Benefício , Mediastino/microbiologia , Mediastino/patologia , Mediastino/cirurgia , Estudos Retrospectivos , Sinais e Sintomas , Pulmão/anatomia & histologia , Pulmão/patologia , Mediastinoscopia/métodos
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