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Juan José Soler-Cataluña,1 Luis Puente Maestu,2 Miguel Román Rodríguez,3 Cristóbal Esteban,4 Joaquín Gea,5 Roberto Bernabeu Mora,6 Eulogio Pleguezuelos Cobo,7 Julio Ancochea,8 Francisco García-Río9 1Hospital Arnau de Vilanova, Valencia, Spain; 2Hospital Gregorio Marañón, Madrid, Spain; 3Centro de Salud Son Pisà, Palma de Mallorca, Spain; 4Hospital de Galdakao, Bilbao (Vizcaya), Spain; 5Hospital del Mar, Barcelona, Spain; 6Hospital General Universitario Morales Meseguer, Murcia, Spain; 7Hospital de Mataró, Mataró (Barcelona), Spain; 8Hospital de La Princesa, Madrid, Spain; 9Hospital La Paz-IdiPAZ, Madrid, SpainCorrespondence: Francisco García-Río, Hospital La Paz, P.° de la Castellana, 261, Madrid, 28046, Spain, Tel +34 917 27 70 00, Email fgr01m@gmail.comPurpose: The Spanish Activity Questionnaire in COPD (SAQ-COPD) is a short, simple physical activity (PA) measurement instrument for patients with chronic obstructive pulmonary disease (COPD). In this study, we analyzed its validity and sensitivity to change.Methods: Prospective scale validation study. An accelerometer (DynaPort MoveMonitor®) and the Yale Physical Activity Survey (YPAS) were used as reference standards. The analyses examined the criterion validity (Spearman correlations), internal consistency (Cronbach’s alpha), factorial structure, test-retest reliability (intraclass correlation coefficient, ICC), sensitivity to change and receiver operating characteristic (ROC) curve to classify patients with low PA.Results: A total of 300 patients diagnosed with COPD were analyzed (73% males, mean age 66 ± 8 years, 40.3% with severe airflow limitation). Cronbach’s alpha was 0.60 and Spearman’s correlations with accelerometer measurements of PA [number of steps, metabolic equivalents (MET), physical activity level (PAL)] and YPAS ranged from 0.37 to 0.53 (all p < 0.001). ICC was 0.69 (95% CI 0.61– 0.74) and the area under the ROC curve to identify low PA was 0.65 (95% confidence interval: 0.58– 0.73). Significant variations in SAQ-COPD scores were found between groups defined by YPAS for change.Conclusion: The SAQ-COPD questionnaire is a valid instrument for classifying PA in patients with COPD. Correlations with other instruments provide criterion validity and also demonstrate good sensitivity to change.Keywords: physical activity, chronic obstructive pulmonary disease, SAQ-COPD, validity, reliability

Alba Ramírez-Sarmiento,1– 3 Orlando Aya,3,4 Diana Cáceres-Rivera,1,2 Carlos F Reyes,2– 4 Angela Espitia,1,2 Camilo Pizarro,3,4 Joaquim Gea,5,6 Victor R Castillo,7,8 Mauricio Orozco-Levi1– 3,6 1Respiratory Department, Instituto Cardiovascular y Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 2EMICON Research Group MINCIENCIAS, Bogotá, Cundinamarca, Colombia; 3Universidad de Santander (UDES), Bucaramanga, Santander, Colombia; 4Department of Critical Care, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 5Respiratory Department, Parc de Salut Mar, Barcelona, Catalonia, Spain; 6CEXS-Universidad Pompeu Fabra, Barcelona, Catalonia, Spain; 7Department of Cardiovascular Surgery, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 8Biomedical and Translational Research Group, Fundación Cardiovascular de Colombia, Floridablanca, Santander, ColombiaCorrespondence: Mauricio Orozco-LeviRespiratory Department, ICV-HIC, Fundación Cardiovascular de Colombia, Calle 155a no. 23-58, El Bosque, Floridablanca, Santander, ColombiaTel +57 3175741421Email mauricioorozco@fcv.orgBackground: Bronchoaspiration of content that accumulates in the supraglottic area (eg, saliva, gastroesophageal reflux) is a risk factor for ventilator-associated pneumonia. A continuous supraglottic suction system may decrease the risk of bronchoaspiration in these patients.Objective: (1) Constructing a conceptual model and functional prototype of a continuous supraglottic suction device for use in humans; (2) defining functional characteristics in ex vivo swine head models; and (3) evaluating its efficacy and safety in mechanically ventilated patients.Methods: Study conducted in three phases. First phase: definition of distances and diameters of the triangle determined by dental arch, posterior oropharynx and vallecula, and diameter of the oropharynx in axial projection; and identification of the declining area of supraglottic suction. Second phase: design engineering and functional prototype evaluated in ex vivo models. Third phase: evaluation of device use in terms of safety and efficacy in ventilated patients.Results: We obtained a final functional model of the SUPRAtube device injected into PVC for medical use. Device effectiveness in in vitro simulation showed a high and fast suction capacity of liquid and thick volumes. Study of swine heads allowed to validate the shape, size and functional fenestration of the device. Study in intubated and mechanically ventilated patients showed a high supraglottic suction capacity and the absence of local adverse events during 72 (7– 240) hours of continuous operation.Conclusion: Our study describes the process of conceptualization, design and production of a practical, safe, low-cost continuous supraglottic suction device without representing antibiotic pressure, which appears to be a new complementary preventive strategy for the standard management of intubated and mechanically ventilated patients.Keywords: mechanical ventilation, bronchoaspiration, supraglottic suction, SUPRAtube, endotracheal tube, gastroesophageal reflux

Clara Martín-Ontiyuelo,1 Anna Rodó-Pin,1 Antonio Sancho-Muñoz,1 Juana Maria Martínez-Llorens,1 Mireia Admetlló,1 Lluis Molina,2 Joaquim Gea,1 Esther Barreiro,1 Diego A Rodríguez Chiaradía1 1Pulmonology Department, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCiii), Barcelona, Spain; 2Cardiology Department, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autónoma de Barcelona (UAB), Barcelona, Spain Abstract: There is evidence that iron plays a key role in the adequate functioning of skeletal muscle. While it has been demonstrated that nonanemic iron deficiency (NAID) affects exercise tolerance and response to exercise training in patients with COPD, the impact on daily physical activities (DPAs) remains unknown. Eighteen COPD patients with NAID (ferritin 6 hours) was higher in patients with NAID compared with controls (73% vs 37%, P3 metabolic equivalents of task, at least 30 minutes) was lower in this group (66% vs 100%, P

Roberto Chalela,1–3 Lluis Gallart,4,5 Sergi Pascual-Guardia,1–3 Antonio Sancho-Muñoz,1,2 Joaquim Gea,1–3 Mauricio Orozco-Levi1–3 1Respiratory Medicine Department, Hospital del Mar-IMIM, Barcelona, Spain; 2Department CEXS, Universitat Pompeu Fabra, Barcelona, Spain; 3CIBERES, ISCIII, Barcelona, Spain; 4Department of Anesthesia, Hospital del Mar-IMIM, Barcelona, Spain; 5Universitat Autònoma de Barcelona, Barcelona, Spain Background: Hypercapnic encephalopathy is relatively frequent in severe exacerbations of COPD (ECOPDs), with its intensity usually being evaluated through clinical scales. Bispectral index (BIS) is a relatively new technique, based on the analysis of the electroencephalographic signal, which provides a good approximation to the level of consciousness, having already been validated in anesthesia. Objective: The objective of the study was to evaluate the utility of BIS in the assessment of the intensity of hypercapnic encephalopathy in ECOPD patients. Patients and methods: A total of ten ECOPD patients were included, and the level of brain activity was assessed using BIS and different scales: Glasgow Coma Scale, Ramsay Sedation Scale (RSS), and Richmond Agitation–Sedation Scale. The evaluation was performed both in the acute phase and 3 months after discharge. Results: BIS was recorded for a total of about 600 minutes. During ECOPD, BIS values ranged from 58.8 (95% CI: 48.6–69) for RSS score of 4 to 92.2 (95% CI: 90.1–94.3) for RSS score of 2. A significant correlation was observed between values obtained with BIS and those from the three scales, although the best fit was for RSS, followed by Glasgow and Richmond (r=-0.757, r=0.701, and r=0.615, respectively; P

Sergi Pascual-Guardia,1–3 Diana Badenes-Bonet,1,2 Clara Martin-Ontiyuelo,1,2 Flavio Zuccarino,4 Judith Marín-Corral,5 Alejandro Rodríguez,3,6 Esther Barreiro,1–3 Joaquim Gea1–3 1Department of Respiratory Medicine, Hospital del Mar-IMIM, Barcelona, Spain; 2Department CEXS, Universitat Pompeu Fabra, Barcelona, Spain; 3CIBERES, ISCiii. Madrid, Spain; 4Department of Imaging, Hospital del Mar, Barcelona, Spain; 5Intensive Care Unit, Hospital del Mar, Research Group in Critical Disorders (GREPAC), IMIM, Barcelona, Spain; 6Intensive Care Unit, Hospital Joan XXIII, Tarragona, Spain Background: Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known.Objective: To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF.Methods: Clinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers).Results: From the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th–75th percentiles, 2–8] vs 3 [1–6] admissions, P