Search

Introduction NECPAL is a tool for identification of patients with advanced chronic disease in need of palliative care. The main objective of the study is to know the prevalence of patients with palliative needs in an acute respiratory ward in a Spanish tertiary hospital using NECPAL. A second objective of the study is to know the annual mortality rate of these patients. Materials and methods Cross sectional study and prospective monitoring of a cohort identified as palliative patients with the NECPAL tool for 12 months. Patient identification was performed in patients admitted to the respiratory ward of our hospital for longer than 3 days. We have assessed the annual vital status (deceased or not deceased) of patients and have recorded demographics, clinical and functional data, as well as the use of healthcare resources. Results We monitored a cohort of 363 patients. Of them, 87 patients (24.3%) (IC 95% 19–30) were identified as NECPAL positive. 60% of patients (n = 64) died within 12 months of their admission. There was no significant difference in the mortality ratio of oncologic versus non oncologic patients. In a multivariable analysis, mortality was associated with demand by patients or relatives for palliative care and with the presence of specific disease progression markers or indicators. Conclusions prevalence of patients with palliative needs in acute respiratory wards is high (one out of four patients). 60% of the patients identified as NECPAL positive in our cohort died in the first 12 months. Training of healthcare professionals as well as availability of appropriate resources are indispensable factors to improve care of this population.

Resumen Introduccion El instrumento NECPAL es una herramienta para la identificacion de personas en situacion de enfermedad cronica avanzada con necesidades paliativas. El objetivo del estudio es conocer la prevalencia de pacientes con necesidades paliativas en un Servicio de Neumologia de un hospital terciario mediante la herramienta NECPAL. Como objetivo secundario se plantea conocer la mortalidad al ano de estos pacientes. Material y metodos Estudio trasversal y seguimiento prospectivo de la cohorte de los pacientes identificados como paliativos con la herramienta NECPAL durante 12 meses. La identificacion se realiza en pacientes ingresados > 3 dias en una planta de Neumologia. Hemos evaluado el estatus vital (fallecido o no fallecido) al ano, asi como datos demograficos clinicos, funcionales y uso de recursos sanitarios. Resultados Se analizaron 363 pacientes. De ellos, 87 (24,3%) (IC 95%, 19-30) fueron identificados como NECPAL positivos. En el seguimiento durante un ano fallecieron 54 pacientes, un 60%. No hubo diferencias en mortalidad entre diagnosticos oncologicos y no oncologicos. En el analisis multivariante, la mortalidad se asocio a la demanda de paciente o familiares de atencion paliativa y a la presencia de indicadores especificos de progresion de la enfermedad. Conclusiones La prevalencia de pacientes con necesidades paliativas en una planta de hospitalizacion de agudos de Neumologia es alta (uno de cada cuatro pacientes). El 60% de los identificados como NECPAL positivos en nuestra serie fallece en los primeros 12 meses. Son necesarios formacion y recursos para atender a estos pacientes.

Introduction: Forced spirometry (FS) is essential for diagnosis and control of respiratory diseases. The aim is to analyze demographic, clinical and spirometric variables by age groups. Method: Retrospective study including all high quality FS (according to clinical guidelines) performed in 140 primary care centers from Sep 2011 to Feb 2019. Variables were divided by age ranges (≤14, 14-65, 65-80 and >80 years). Results: 56,515 FS were performed: 6,149 in ≤14 years (y), 36,732 in 14-65y, 11,662 in 65-80y and 1,972 in >80y. Asthma was the main previous diagnosis in the 0-65y group and COPD in the 65-95y group. In 14-65y group most of the tests are done for diagnosis and in the rest of ranges for control. In the FS performed for diagnosis, positive Post-Bronchodilator test (PBD) was detected in 2.4% of patients ≤14y, 22.1% in 14-65y, 17.4% in 65-80y and 11.7% in >80y. FEV1/FVC PBD 80y (45.3% smoking history). Tables 1 and 2 show spirometric data classified by age groups and subclassified by previous diagnoses of asthma and COPD. Conclusions: The main pre-diagnosis 80y. Considerable number of patients had previous COPD diagnosed without obstruction in PDB spirometry.

Introduction: The aim was to evaluate the clinical characteristics and evolution of community acquired pneumonia with associated paraneumonic pleural effusion(PE-CAP). Methods: Prospective observational study of all immunocompetent patients hospitalized for PE-CAP in our Pulmonology Service between 2005 and 2019.We considered PE-CAP when compatible radiology.Pleural effusion (PE) was classified as complicated based on its biochemical and/or radiological characteristics.Empyema criteria:macroscopic pus or germs in microbiological analysis of pleural fluid (PF). Results: 3417 patients, of which 221(6.5%) had PE. PF analysis was performed in 158 patients, of which in 134 cases the microbiology was negative and in 24 positive (9 Streptococcus spp.,8 S.pneumoniae,3 S.aureus,3 S.viridans,1 Eikinella corrodens). Bacteremia was observed in 34(15.4%) patients with PE: 31 cases S.pneumoniae,2 S.pyogenes and 1 S. viridans. Positive blood culture and positive microbiology of PF were observed in 4 patients (3 S.pneumoniae and 1 S.viridans). Conclusions: 6.5% of our patients had PE-CAP but only 1.9% complicated PE. Microbiological diagnosis was obtained in 15% of analyzed PF, and S. pneumoniae was the most frequent microorganism. Patients with CAP and PE were younger, less frequently vaccinated and with less comorbidities.They had more bacteremia, therapeutic failure,longer hospital stay,and later clinical stability, although they had similar mortality.

Objective: Analyze the role of a new-onset atrial arrhythmia (AA) in the prognosis of pneumococcal pneumonia(PP). Methods: Prospective observational study, including immunocompetent adults hospitalized for PP in 2 hospitals for a 18 year period. The bacteriological diagnosis was based on the result of urinary antigen test and/or blood culture. We evaluated patients with PP who presented a new-onset AA during hospitalization and classified them according to the time (early AA -on hospital admission- or late- 24h after admission) and the duration of the AA (paroxysmal or persistent). All survived patients were followed-up for 6- months period after discharged. Patients with stable or exacerbated chronic AA were excluded. Survival was analyzed using the Kaplan-Meier method. Results: 1092 patients included. Of them 109 had a new-onset AA. An early AA was documented in 87 patients and late onset in 22. AA was persistent in 31 patients and paroxysmal in 78.Figure 1:demographics and in-hospital outcomes.Figure 2: Kaplan-Meier survival curve for patients according to time and duration of the AA (p Conclusions: 1.Nearly 8.3% of patients had a new AA during their hospitalization for PP. 2.New onset AA was associated with worst outcome and higher mortality. 3. Late and persistent new-onset AA were associated with worse prognosis.

Introduction: DMD affects 1/3500 males. The most frequent cause of death is ventilatory failure.90% of patients who do not use MV die before 20 years. Aim: To describe the characteristics of patients with DMD treated in our hospital in the last 20 years Methods: Retrospective study. We collected:age, cardiopathy, date of death, use of MV and starting age, elective or after an exacerbation, ventilatory mode, use of Cough Assist, gastrostomy and scoliosis surgery. Functional tests and polygraphy previous starting respiratory theraphy were analyzed. Results: 19 DMD males.57,8% has MV and is controlled by Pulmonologists.52,3% require Cough Assist and 10,5% gastrostomy. Cardiac affectation in 57,8% and 36,8% has scoliosis surgery. During this time 5 patients died at the age of 26 +/- 6,52 years. MV was initiated in 11 patients at 19y(15-25) and mean time with MV was 6 y(1-9).90.9% non-invasive/1 Invasive.45.4% MV was initiated acutely during an admission. Characteristics of MV are shown in Table1. A combined Pediatric-Pneumology assestment has been started since 2017. Conclusions: DMD is a rare disease in our area.57,8% of patients require MV and Cough assist and are controlled by pulmonologists Mainly MV starts in the adolescence and in 45,4% of cases after an acute process. Recently, a process coordination between Pediatrics and Pulmonologists has begun to improve the care of these patients.

Objective: identify the microbial aetiology of community acquired pneumonia (CAP) and analyze it´s relationship with the pneumonia severity on admission. Methods: prospective observational study of all immunocompetent patients admitted for CAP to our Hospital between 11/2005 and 06/2018. Bacteriological diagnosis was obtained from urinary antigen test (UAT) for Legionella and S. pneumoniae, blood culture (BC), serologic test for atypical bacteria (SAB), pharyngeal swab for respiratory viruses, bronchoscopy or thoracocentesis. Pneumonia severity was estimated by PSI score. Results: 3306 patients (1210 women), mean age:63.3 years;etiology obtained in 1150. BC performed in 2303 (69.7%), being positive in 7.8%. UAT performed in 99.5%, positive for S. pneumoniae in 23.2% and for Legionella in 3.7%. SAB performed in 257 (7.7%), 38 positive. Bronchoscopy performed in 207 patients obtaining microbial aetiology in 22. Microorganisms observed in the pleural fluid of 18 patients. Table 1: relationship between microbial diagnosis and PSI. Table 2: profitability of UAT and BC in pneumococcal pneumonia according to PSI. Conclusions: 1. Bacteriological diagnosis was obtained in almost 35% of the patients, with pneumococcus being the microorganism most frequently identified. 2. Patients with a microbiological diagnosis had higher PSI score. 3. This correlation is due to the identification of S. pneumoniae, not being evident in the rest of microorganisms

Aim: Analyze clinical-radiological features and clinical course of M.kansasii pulmonary disease compared to other NTMs Methods: Retrospective, descriptive study of NTM pulmonary disease from 1997 to 2016. 2007 ATS criteria were fulfilled. We evaluated:demographic data, risk factors, symptomatology, radiology, coinfection, recurrence and overall mortality per year Results: 327cases of NTM lung disease:274(83.7%)M. Kansasii and 53(16.3%)other NTM. Comparison between them are seen in figure1.M. Kansasii group, patients were younger, males, smokers and with cancer. No differences were found in symptoms.M. kansasii was associated with more cavitation, unilaterality and upper lobes predominance. Other NTMs infections were associated with bronchiectasis, nodules or “tree in bud” infiltrates with middle lobes predominance and more coinfection. Rates of recurrence were similar in both groups and the overall-1year mortality rate, including NTMosis-related mortality and other causes mortality. Sputum conversion was maintained in 85.8% of M.kansasii vs 75.5% in other NTM and radiological resolution in 60%vs39% Conclusions: There are relevant differences between M. Kansasii lung infections and those caused by other NTMs:1. They appear to occur more in male smokers, in the fifth decade and with a history of neoplasia 2. They are associated with cavitation, unilaterality and upper lobe predominance 3. Sputum conversion and radiological resolution rates are higher

Sleep-Disordered Breathing in MD-1 patients are common:obstructive sleep apnea (OSA), central apneas and nocturnal hypoventilacion Aim: To determine whether there is a relationship between sleep breathing disorders and clinical parameters such as symptoms of OSA, pulmonary function and degree of neuromuscular impairment Methods: Retrospective descriptive study of MD-1patients. We collected:symptoms of OSA and/or nocturnal hypoventilation, spirometry, arterial blood gases and muscle pressures and sleep test results. We analyzed the factors related to the presence of moderate OSA (AHI >15) Results: Patient´s characteristics in figure1.47patients(51%men /49%women), mean age 47.8 with BMI ≥30 in 27.7%. Only 36% reported any symptoms of OSA and/or nocturnal hypoventilation. 87% presented an AHI>5, with central apnea predominance in 44%. Factors related to AHI>15 are presented in figure2. A low nocturnal SATO2, with a CT90>10% was related to have an AHI >15. No differences were found in age, sex, obesity, OSA symptoms, pCO2 levels or functional parameters (FVC, MIP, MEP). Conclusions: 1)OSA is very common in MD1, with a high number of central apneas.2)It cannot be predicted on the symptoms, functional respiratory test or diurnal hypercapnia.3)Having a low nocturnal SATO2 and a CT 90> 10% are related to an IAH>15.4)So, we believe that nocturnal oximetry can have an important role in determining when to perform a sleep test, which will be preferably a PSG with capnography

Introduction: Impulse oscillometry (IOS) is a diagnostic technique for the assessment of airway resistance, non-invasively and with minimal patient cooperation. Unlike other techniques that measure airway resistance, the parameters come from the response of the respiratory system to an external stimulus. The objective of this study was to evaluate the correlation between IOS and spirometry(EF) in a children population at baseline and in the response to bronchodilator test. Method: We performed IOS using a Jaeger Master screen equipment. They were applied in the mouth and, through a loudspeaker, pressure waves in the form of pulses in every 0.1 seconds on spontaneous breathing. We evaluated the correlation at baseline and after BD between IOS and spirometric parameters. Three acceptable and reproducible maneuvers were performed, both for EF and IOS. Results: We included 58 patients with diagnosis of asthma and controlled in Pediatric Pneumology. Oscilometry and spirometry were performed in all patients, at baseline and after administration of B2 agonist. In table 1 we presented the correlation between the different parameters at baseline and in the response to BD. Conclusions: 1. We obtained aceptable correlations between both techniques at baseline and in the BD response. 2. Impulse oscilometry is easy to perform and shows a good correlation with spirometric parameters, so it could be used in the pediatric age to evaluate bronchodilator response.