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1. Factores que condicionan la pérdida de control al reducir escalones terapéuticos en el tratamiento del asma moderada-grave en la práctica clínica habitual: estudio español multicéntrico

Author

Andújar Espinosa Rubén, Rodríguez Rodríguez Mercedes, Rivera Ortún M. Luisa, Velasco Azagra Marta, Arcalá Campillo Eduardo, Moreno Fernández Antonio, Álvarez Fernández Jose Antonio, De Higes Martínez Eva Belén, Audicana Berasategui María Teresa, González Mancebo Eloina, Prieto Prieto Joaquina, Herráez Herrera Pilar de Lys, Valverde Vazquez Lucía, Escribano Rodríguez M. Mar, Cueva Oliver Begoña, Lahuerta Castro Adolfo, Prieto Montaño Patricia, Torrecillas Toro Miguel, Zorrilla Lorenzo Vanessa, Peña Miguel Teresa, Moscardó Orenes Miguel Ángel, Ahmida Tahar, Blanco González M. Rosa, Bernabeu Mora Roberto, Dorronsoro Quintana Silvia, Mengual Macenlle Noemí, Royo Prats Juan Antonio, Marcos Durantez Marisa, Fernández García Domingo, Alcalde Rumayor María Consuelo, Gutiérrez Fernández Diego, Marcos Rodríguez Pedro Jorge, Martín Lázaro Joaquín, Berastegui García Cristina, Blanco Aparicio Marina, Entrenas Costa Luis Manuel, García Romero de Tejada Jose Andrés, E. Martínez-Moragón, Sevillano Martín Carracedo, Soria Esojo Carmen, Jiménez Rodríguez Teodorikez Wilfox, Herrero Mosquete María Ruth, Nuñez Orjales Ramón, Antepara Ercoreca Ignacio, Tábara Rodríguez Julia, Ferrer Torres Ángel, González Fernández Teresa, Bobolea Irina, Bentabol Manzanares Miguel, García Muñoz Juan Pablo, Laita Legarreta Amaia, Morchon Miguel Eva Maria, Carballada González Francisco, Rodríguez Jiménez Beatriz, De Luiz Martínez Gustavo, Rojas Vílchez María José, Velez Ruiz de Lobera Adolfo, Vázquez Fuertes Laura, Campano Lancharro Francisco Javier, Fernández Pellon Luis, Losada Llorente Paula, González Barcala Francisco-Javier, Galindo Bonilla Pedro, Ortiz Portal Félix, Gómez Nieves María Estela, Aisa Carpio Diego, Ramos Pinedo Ángela, Miranda Paez Alfonso, Martínez Olondris Pilar, Padilla Galo Alicia, Cruz Molina Jose María, Planas Coimerma Francisco, Navarro Echeverria Jose Antonio, Compaired Villa Jose Santonio, Pedraza Serrano Fernando, Florido López José Fernando, Herrero Martín Sonia, Almagro López Juan Alfonso, Morales Chacón Beatriz, Cimarra Álvarez Mercedes, T. Fernández-Sánchez, Aparicio Español Santiago, Salvador Segarra María Dolores, Pinto Nogués Ester, Jiménez López Jesús, González Seco Emma, Barceló Muñoz José Manuel, Muñoz Gall Xavier, Soto Venegas Antonia Dolores, García Paz Vanessa, en nombre del grupo de investigación Step, García Pazos Jose Manuel, López Giraldo Alejandra, Mohedano Vicente Ester, Ojeda Castillejo Elena, Blanco Reinosa Begoña, Ansotegui Zubeldia Ignacio, Trujillo Trujillo María Jesús, Díaz Campos Rocío Magdalena, Dacal Quintas Raquel, Serra Batlles Joan, Luengo Sánchez Olga, Iriberri Pascual María Milagros, Martínez Rivera Carlos, Alvarado Izquierdo María Isabel, Iriarte Sotes Pilar, Sánchez González María José, Gil Muñoz Francisco Luis, S. Mogrovejo, Valldeperas Combas Joan, González Torralba Fernando, Serrano Gutiérrez Virginia, Peña Acevedo Acevedo Yesenia, Ruiz Peña Antonio, Alcázar Ramírez Alcázar Ramírez José, Abellán Alemán Ángel Francisco, Henríquez Santana Aythamy, Landete Rodríguez Pedro, Soto Retes Lorena, García Rodríguez Leticia, Raducan Isabela, Hinojosa Jara Belén, Cano Aguirre M. del Puerto, Muñoz García Esther, López-Muñiz Ballesteros Belén, Juanola Pla Jordi, Carrillo Arias Fernando, García Núñez Ignacio, Yago Meniz Alexandra, Gutiérrez Urra Tamara, Lara Alcon Silvia, De La Rosa Carrillo David, Alwakil Olbah Michael, Vila Albelda Concepción, Figueroa de la Guardia Eduardo, Quílez Ruiz-Rico Natividad, Herrerías Peña Miguel, Crespo Lessmann Astrid, Suárez Antelo Juan, Portillo Carroz Karina, Vila Giralte Xavier, Lara Jiménez María Ángeles, Ortega Sáenz de Tejada Ezequiel, Gandolfo Cano María del Mar, Acero Sainz Sara, Alonso Viteri Soledad, Alonso Gil Lidia, Sabater Talaverano Gladis, Sogo Sagardía Ana, Zapata Yebenes Juan José, Hurtado de Mendoza Ruibio Nieves, Molina Nieto Fernando, Cegoñino de Sus Joaquín, Sabadell Nieto Carlos, Benito Martínez Patricia, Pérez Estrada Cornejo Manuel, Tatay Soler Frederic, Vila Auli Brian, Mata Calderón Patricia, Levy Naon Alberto, Moreno García Victoria, Jaca Michelena Carmen, Serra Mitjà Pere, Arnedillo Muñoz Aurelio, Resano Lizaldre Alfredo, Pérez Rojo Raquel, Rosado Ingelmo Ana, Antolín Amerigo Darío, Chic Palacín Susana, Cardenas Contreras Remedios, Angrill Sellés Núria, González Delgado Purificación, Fernández Parra Beatriz, Aguilar Perez Grovas Ricardo Ismael, J. Delgado, Riba Blanch Antoni, Frias Jiménez Marta, Sánchez Berenguer Dan, Linde de Luna Francisco, and Letran Camacho Antonio

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, General Medicine, business, Humanities
Abstract

Resumen Introduccion Aunque las guias de practica clinica recomiendan un ajuste continuado del tratamiento del asma, reduciendo la medicacion de mantenimiento cuando se alcanza el control (step-down), existen pocos estudios de practica clinica habitual orientados a recabar informacion de los factores que condicionan su fracaso. Objetivo Determinar los factores que condicionan en la practica clinica habitual el fracaso del step-down en los pacientes asmaticos moderados-graves controlados con una combinacion de glucocorticoides inhalados/agonistas beta-2 adrenergicos de accion larga. Metodo Estudio multicentrico retrospectivo sobre 374 pacientes con asma moderada-grave controlada con glucocorticoides inhalados/agonistas beta-2 adrenergicos de accion larga en quienes el facultativo indico en 2016 un step-down. Resultados El step-down fracaso en el 41,7%. Los factores relacionados con el fracaso fueron: la mayor edad del paciente (p = 0,006), la presencia de 2 o mas comorbilidades (p = 0,016), el mayor nivel de gravedad (persistente grave vs. persistente moderada) (p 40 anos) (p = 0,045), cuanto mas alto es el escalon terapeutico previo (p = 0,003) y posterior al cambio (p Conclusion En condiciones de practica clinica habitual el step-down fracasa en un porcentaje alto de pacientes y se recomienda indicarlo cuando el paciente lleve mas de 6 meses controlado.

Published
2020

2. Factors that determine the loss of control when reducing therapy by steps in the treatment of moderate-severe asthma in standard clinical practice: A multicentre Spanish study

Author

Zapata Yebenes Juan José, Vila Auli Brian, González Delgado Purificación, Hurtado de Mendoza Ruibio Nieves, Vila Giralte Xavier, Florido López José Fernando, Mata Calderón Patricia, De Higes Martínez Eva Belén, Almagro López Juan Alfonso, Peña Acevedo Acevedo Yesenia, Carballada González Francisco, Jiménez López Jesús, Navarro Echeverria Jose Antonio, Compaired Villa Jose Santonio, Levy Naon Alberto, Losada Llorente Paula, Martínez Olondris Pilar, Moreno García Victoria, Mohedano Vicente Ester, Barceló Muñoz José Manuel, Alonso Viteri Soledad, Alonso Gil Lidia, Aguilar Perez Grovas Ricardo Ismael, Jaca Michelena Carmen, en nombre del grupo de investigación Step, García Pazos Jose Manuel, Dacal Quintas Raquel, Cimarra Álvarez Mercedes, Salvador Segarra María Dolores, Torrecillas Toro Miguel, Gutiérrez Fernández Diego, Iriarte Sotes Pilar, Serra Mitjà Pere, López Giraldo Alejandra, Sabater Talaverano Gladis, Berastegui García Cristina, Álvarez Fernández Jose Antonio, Raducan Isabela, Hinojosa Jara Belén, Blanco Aparicio Marina, Rivera Ortún M. Luisa, Sogo Sagardía Ana, Cegoñino de Sus Joaquín, Pérez Rojo Raquel, Prieto Montaño Patricia, García Romero de Tejada Jose Andrés, Soto Venegas Antonia Dolores, García Paz Vanessa, Dorronsoro Quintana Silvia, S. Mogrovejo, Valverde Vazquez Lucía, Peña Miguel Teresa, Fernández García Domingo, Serrano Gutiérrez Virginia, Moscardó Orenes Miguel Ángel, Rosado Ingelmo Ana, Sabadell Nieto Carlos, Lara Jiménez María Ángeles, Ortega Sáenz de Tejada Ezequiel, Molina Nieto Fernando, Soto Retes Lorena, Mengual Macenlle Noemí, Rodríguez Jiménez Beatriz, Gandolfo Cano María del Mar, Antolín Amerigo Darío, Chic Palacín Susana, Acero Sainz Sara, Herrero Mosquete María Ruth, Moreno Fernández Antonio, Entrenas Costa Luis Manuel, Lara Alcon Silvia, Sánchez González María José, Cardenas Contreras Remedios, González Mancebo Eloina, Rojas Vílchez María José, Zorrilla Lorenzo Vanessa, Rodríguez Rodríguez Mercedes, González Barcala Francisco-Javier, Vázquez Fuertes Laura, De La Rosa Carrillo David, Alwakil Olbah Michael, Galindo Bonilla Pedro, Campano Lancharro Francisco Javier, Fernández Pellon Luis, Fernández Parra Beatriz, Quílez Ruiz-Rico Natividad, Herrerías Peña Miguel, Benito Martínez Patricia, Pérez Estrada Cornejo Manuel, Aparicio Español Santiago, Velasco Azagra Marta, Arcalá Campillo Eduardo, Alcalde Rumayor María Consuelo, Aisa Carpio Diego, Miranda Paez Alfonso, Tatay Soler Frederic, Sevillano Martín Carracedo, Gómez Nieves María Estela, González Seco Emma, De Luiz Martínez Gustavo, Planas Coimerma Francisco, Angrill Sellés Núria, Cruz Molina Jose María, Soria Esojo Carmen, Bentabol Manzanares Miguel, Blanco Reinosa Begoña, Martínez Rivera Carlos, Ansotegui Zubeldia Ignacio, Audicana Berasategui María Teresa, Iriberri Pascual María Milagros, Alvarado Izquierdo María Isabel, Valldeperas Combas Joan, Herráez Herrera Pilar de Lys, Velez Ruiz de Lobera Adolfo, González Fernández Teresa, Blanco González M. Rosa, Marcos Durantez Marisa, Linde de Luna Francisco, Letran Camacho Antonio, Bernabeu Mora Roberto, Sánchez Berenguer Dan, Muñoz García Esther, Jiménez Rodríguez Teodorikez Wilfox, Padilla Galo Alicia, García Muñoz Juan Pablo, Arnedillo Muñoz Aurelio, Vila Albelda Concepción, Figueroa de la Guardia Eduardo, Laita Legarreta Amaia, Andújar Espinosa Rubén, Crespo Lessmann Astrid, T. Fernández-Sánchez, J. Delgado, Abellán Alemán Ángel Francisco, Escribano Rodríguez M. Mar, Resano Lizaldre Alfredo, Portillo Carroz Karina, Yago Meniz Alexandra, Riba Blanch Antoni, Martín Lázaro Joaquín, Ortiz Portal Félix, Frias Jiménez Marta, Royo Prats Juan Antonio, Pedraza Serrano Fernando, Pinto Nogués Ester, Díaz Campos Rocío Magdalena, Luengo Sánchez Olga, Serra Batlles Joan, Bobolea Irina, Ojeda Castillejo Elena, González Torralba Fernando, E. Martínez-Moragón, Ruiz Peña Antonio, Alcázar Ramírez Alcázar Ramírez José, Nuñez Orjales Ramón, Trujillo Trujillo María Jesús, Gil Muñoz Francisco Luis, Morales Chacón Beatriz, Morchon Miguel Eva Maria, Carrillo Arias Fernando, García Núñez Ignacio, Ramos Pinedo Ángela, Gutiérrez Urra Tamara, Ahmida Tahar, Marcos Rodríguez Pedro Jorge, Henríquez Santana Aythamy, Landete Rodríguez Pedro, Suárez Antelo Juan, García Rodríguez Leticia, Cano Aguirre M. del Puerto, López-Muñiz Ballesteros Belén, Juanola Pla Jordi, Muñoz Gall Xavier, Antepara Ercoreca Ignacio, Tábara Rodríguez Julia, Ferrer Torres Ángel, Herrero Martín Sonia, Prieto Prieto Joaquina, Cueva Oliver Begoña, and Lahuerta Castro Adolfo

Subjects
medicine.medical_specialty, business.industry, Severe asthma, Asthma treatment, Retrospective cohort study, General Medicine, medicine.disease, Disease control, Clinical Practice, 03 medical and health sciences, 0302 clinical medicine, Patient age, Internal medicine, medicine, 030212 general & internal medicine, Severity level, business, Asthma
Abstract

Although the clinical practice guidelines recommend continuous adjustment of asthma treatment and reducing the maintenance drugs when achieving control (step-down), there are few studies of standard clinical practice aimed at collecting information on the factors that determine step-down failure.To determine the factors that determine step-down failure in standard clinical practice of patients with moderate-severe asthma controlled by a combination of inhaled glucocorticoids and long-acting beta agonists.A multicentre retrospective study included 374 patients with moderate-severe asthma controlled with inhaled glucocorticoids and long-acting beta agonists for whom the physician indicated a step-down in 2016.The step-down failed in 41.7% of the patients. The following factors were related to failure: greater patient age (P=.006), presence of at least 2 comorbidities (P=.016), greater severity level (severe persistent vs. moderate persistent) (P.001), greater age at diagnosis (40 years) (P=.045), the higher the therapeutic step before (P=.003) and after the change (P.001), the shorter the time of improvement/control prior to the change (P=.019), lower FEVIn standard clinical practice conditions, step-down fails in a high percentage of patients, and the suggestion is to indicate step-down when the patient has had more than 6 months of disease control.

Published
2020

3. Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Author

Luisa Bordeje, M., Montejo, Juan C., Lidon Mateu, M., Solera, Manuel, Acosta, Jose A., Juan, Mar, Garcia-Cordoba, Francisco, Garcia-Martinez, Miguel A., Gastaldo, Rosa, Acosta, Jose, Albert, Inmaculada, Alec, Alfonso, Luisa Bordeje, Ma, Calvo, Enrique, Ferre, Merce, Garcia de Lorenzo, Abelardo, Angel Garcia-Martinez, Miguel, Gonzalez-Iglesias, Carlos, Iglesias, Rayden, Lorencio, Carol, Martinez de la Gandara, Amalia, Lidon Mateu, Ma, Mesejo, Alfonso, Martinez-Garcia, Pilar, Carlos Montejo, Juan, Luisa Navarrete, Ma, Ortiz-Leyba, Carlos, Robles, Angel, Sanchez-Alvarez, Carmen, Vaquerizo, Clara, Vila, Belen, Carlos Yebenes, Juan, Zabarte, Mercedes, and PIANE STUDY GRP SPAIN

Subjects
Male, Gastrointestinal Diseases - etiology, Gastrointestinal Diseases, medicine.medical_treatment, humanos, asistencia del enfermo crítico, intensive care unit, Gastroenterology, Enteral administration, Group B, law.invention, 0302 clinical medicine, law, estudios prospectivos, Abdomen, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, mediana edad, anciano, Nutrition and Dietetics, Respiration, enfermedades gastrointestinales, respiración, gastrointestinal complications, Middle Aged, Intensive care unit, Intensive Care Units, presión, medicine.anatomical_structure, intra-abdominal pressure, Female, lcsh:Nutrition. Foods and food supply, medicine.medical_specialty, Critical Care, Critical Illness, unidades de cuidados intensivos, enfermedad crítica, lcsh:TX341-641, Article, enteral nutrition intolerance, 03 medical and health sciences, Internal medicine, Pressure, medicine, Humans, enteral nutrition, nutrición enteral, Aged, Mechanical ventilation, business.industry, 030208 emergency & critical care medicine, Respiration, Artificial, Critical Illness - therapy, Parenteral nutrition, business, Complication, Biomarkers, Food Science
Abstract

To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications, to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p &lt, 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p &lt, 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.

Published
2019

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