Browsing by Subject "Mechanical ventilation"

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    Early radiological worsening of SARS‑CoV‑2 pneumonia predicts the need for ventilatory support
    (Springer, 2022-01-16) Plasencia‑Martínez, Juana María; Carrillo‑Alcaraz, Andrés; Martín Cascón, Miguel; Pérez‑Costa, Rafael; Ballesta Ruiz, Mónica; Blanco‑Barrio, Ana; Herves‑Escobedo, Ignacio; Gómez‑Verdú, José‑Miguel; Alcaraz‑Martínez, Julián; Alemán‑Belando, Sergio; Carrillo‑Burgos, María José; Ciencias Sociosanitarias; Facultad de Enfermería
    Objectives: Identifying early markers of poor prognosis of coronavirus disease 2019 (COVID-19) is mandatory. Our purpose is to analyze by chest radiography if rapid worsening of COVID-19 pneumonia in the initial days has predictive value for ventilatory support (VS) need. Methods: Ambispective observational ethically approved study in COVID-19 pneumonia inpatients, validated in a second outpatient sample. Brixia score (BS) was applied to the first and second chest radiography required for suspected COVID-19 pneumonia to determine the predictive capacity of BS worsening for VS need. Intraclass correlation coefficient (ICC) was previously analyzed among three radiologists. Sensitivity, specificity, likelihood ratios, AUC, and odds ratio were calculated using ROC curves and binary logistic regression analysis. A value of p < .05 was considered statistically significant. Results: A total of 120 inpatients (55 ± 14 years, 68 men) and 112 outpatients (56 ± 13 years, 61 men) were recruited. The average ICC of the BS was between 0.812 (95% confidence interval 0.745–0.878) and 0.906 (95% confidence interval 0.844–0.940). According to the multivariate analysis, a BS worsening per day > 1.3 points within 10 days of the onset of symptoms doubles the risk for requiring VS in inpatients and 5 times in outpatients (p < .001). The findings from the second chest radiography were always better predictors of VS requirement than those from the first one. Conclusion: The early radiological worsening of SARS-CoV-2 pneumonia after symptoms onset is a determining factor of the final prognosis. In elderly patients with some comorbidity and pneumonia, a 48–72-h follow-up radiograph is recommended.
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    Impact of early caffeine therapy in preterm newborns on infant lung function
    (Wiley, 2019-10-06) Sánchez-Solís de Querol, Manuel; García-Marcos, Patricia W.; Agüera‐Arenas, Juan; Mondéjar López, Pedro Enrique; García-Marcos Álvarez, Luis Vicente; Cirugía, Pediatría y Obstetricia y Ginecología; Facultade de Medicina
    Objective: To know the effect of caffeine therapy on infant lung function in preterm infants with a gestational age less than 31 weeks. Material and Methods: Forced vital capacity (FVC), forced expiratory volume at 0.5 seconds (FEV0.5), and forced expiratory flows were measured by raised volume rapid thoracoabdominal compression technique; functional residual capacity was measured by plethysmography (FRCpleth). Compliance of the respiratory system was measured by a single interruption technique (Crs). The Student t test was used to compare lung function measurements between the two groups: treated versus nontreated with caffeine. A multivariate analysis was carried out considering each and every lung function parameter (z‐score) as the dependent variable; and gender, gestational age, birth weight (z‐score), corrected age, invasive mechanical ventilation (yes/no), and bronchopulmonary dysplasia (BPD) diagnosis (yes/no) as independent ones. Additionally, stratified analyses by BPD diagnosis were performed. Results: The multivariate analysis showed significant higher z‐scores of FVC and FEV0.5 in preterm infants treated with caffeine (P=.004 and P=.024, respectively). This result only being significant in the group of non‐BPD infants (P=.021 and P=.042), after stratifying by BPD diagnosis. Differences were not found in z‐scores of FEV0.5/FVC, FEF75, FEF25‐75, FRCpleth, nor Crs. Conclusion: Lung function (FVC and FEV0.5) is improved in infants born under 31 weeks of gestation when treated with caffeine. This improvement is driven by the group of infants who did not suffer from BPD. Overall, our results show that there is an early beneficial effect of caffeine treatment in infant lung function.
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    Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network
    (Springer Nature, 2021-10-01) Ramos-Navarro, Cristina; Maderuelo‑Rodríguez, Elena; Concheiro‑Guisán, Ana; Pérez‑Tarazona, Santiago; Rueda‑Esteban, Santiago; Sánchez‑Torres, Ana; Sánchez-Solís de Querol, Manuel; Sanz‑López, Ester; Sánchez‑Luna, Manuel; GEIDIS Research Network; Cirugía, Pediatría y Obstetricia y Ginecología; Facultad de Medicina
    GEIDIS is a national-based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow-up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1755 preterm patients diagnosed with BPD. Of the total sample, 90.6% (n = 1591) were less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8-28.5) and median birth weight 885 g (740-1,070 g). A total of 52.5% (n = 922) were classified as mild (type 1), 25.3% (n = 444) were moderate (type 2), and 22.2% (n = 389) were severe BPD (type 3). In patients born at under 30 weeks' gestation, most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, nosocomial pneumonia, and the length of exposure to MV. Conclusion: In this national-based research-net registry of BPD patients, the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks' postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30. What is Known: • BPD is a highly complex multifactorial disease associated with preterm birth. What is New: • The length of exposure to mechanical ventilation is the most important postnatal risk factor associated to bronchopulmonary severity which modulate the effect of most pre and postnatal risk factors. • Among patients with BPD, the requirement for FiO2 >.30% at 36 weeks of postmenstrual age is associated with greater morbidity during hospitalization and at discharge.