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Biomedical subjects

C Rodrigo

Publications and source records attributed to C Rodrigo.

At least 19 recordsLinked to original sources
PubMed2006

Heliox for nonintubated acute asthma patients.

BACKGROUND: Helium and oxygen mixtures (heliox), have been used sporadically in respiratory medicine for decades. Their use in acute respiratory emergencies such as asthma has been the subject of considerable debate. Despite the lapse of more than 60 years since it was first proposed, the role of heliox in treating patients with severe acute asthma remains unclear. OBJECTIVES: To determine the effect of the addition of heliox to standard medical care on the course of acute asthma, as measured by pulmonary function testing and clinical endpoints. SEARCH STRATEGY: Randomised controlled trials were identified from the Cochrane Airways Group Specialised Register. In addition, we contacted primary authors and experts and searched reference lists of articles. Searches are current to August 2005. SELECTION CRITERIA: 1) randomised, single or double blind, controlled trials; 2) children or adults with a clinical diagnosis of acute asthma seen in emergency departments or equivalent acute care settings; and 3) compared treatment with inhaled heliox to placebo (oxygen or air). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion and quality assessment; disagreement was resolved by a third review author and consensus. MAIN RESULTS: This review has been updated in 2006 to include four new trials giving atotal of ten trials involving 544 acute asthma patients. Seven studies involved adults and three studies dealt solely with children. Three were assessed as high quality (Jadad score > 3). Pulmonary function tests were recorded during heliox administration (15 to 60 min). Pooling of the eight trials contributing data to this review showed no significant group differences (standardised mean differences -0.28; 95% confidence interval (CI) -0.56 to 0.01). There was significant heterogeneity among the studies. Heliox use did improve pulmonary function only in the subgroup of patients with the most severe baseline pulmonary function impairment; however, this conclusion is based on a small number of studies. There were no significant differences between groups when adults versus children, and high versus low heliox dose studies were compared. Finally, at the end of treatment, participants treated with heliox showed no significant different risk of admission to hospital (RR 0.83 (95%CI 0.66 to 1.08, P = 0.17, I(2) = 0%). AUTHORS' CONCLUSIONS: The existing evidence does not provide support for the administration of helium-oxygen mixtures to all ED patients with acute asthma. At this time, heliox treatment does not have a role to play in the initial treatment of patients with acute asthma. Nevertheless, new evidence suggests certain beneficial effects in patients with more severe obstruction. Since these conclusions are based upon between-group comparisons and small studies, they should be interpreted with caution.

Acute Disease↗
PubMed2006

[Prognosis for acute exacerbation of chronic obstructive pulmonary disease in mechanically ventilated patients].

OBJECTIVE: To determine the variables associated with prognosis for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in mechanically ventilated patients. DESIGN: Prospective cohort study with retrospective analysis. LOCATION: 361 Intensive Care Units (ICU) in 20 countries. PATIENTS AND METHODS: There were included in the study 522 patients who required mechanical ventilation for more than 12 hours due to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In order to determine those variables associated with mortality, there was performed a recursive partition analysis in which the following variables were included: demographics, arterial blood gas prior to intubation, complications arising during mechanical ventilation (barotrauma, acute respiratory distress syndrome, ventilator-associated pneumonia, sepsis), organ dysfunction (cardiovascular, renal, liver, coagulation) and duration of ventilatory support. INTERVENTIONS: None. VARIABLES OF PRIME IMPORTANCE: ICU mortality. RESULTS: ICU and hospital mortality rates were 22% and 30%, respectively. Variables associated with mortality were cardiovascular dysfunction, renal dysfunction and duration of ventilatory support > 18 days. Median durations were as follows: mechanical ventilatory support, 4 days (P25: 2, P75: 6); weaning from ventilatory support, 2 days (P25: 1, P75: 5); stay in intensive care unit, 8 days (P25: 5, P75: 13); stay in hospital, 17 days (P25: 10, P75: 27). CONCLUSIONS: Mortality in the studied cohort of patients with AECOPD was associated with cardiovascular dysfunction, renal dysfunction and prolonged mechanical support.

Acute Disease↗
PubMed2006

[Severe acute asthma: its management in emergency visits and intensive care].

All patients with asthma are at risk of suffering an acute asthma attack over their lifetime, and these may finally be fatal. Hospitalizations and emergency department visits and intensive care account for a large proportion of the health-care cost burden of asthma. Thus, it is especially important to establish plans for prevention, education and therapeutic rationalization of primary care that establishes the disease and decreases its worsening. The severity of the exacerbations may vary from a mild to life threatening. The mortality is basically linked to inadequate assessment of the patient's severity. This leads to inadequate treatment in the emergency and delay in the patient's hospitalization. This review describes the epidemiology, costs, pathophysiology, mortality and management of adult acute asthma patients in the emergency department and intensive care, especially that related to non-invasive mechanical ventilation and conventional forms of mechanical respiratory care, with the current changes in its operational strategy.

Adult↗
PubMed2005

Effect of storage period under variable conditions on the chemical and physical composition and colour of Spanish refrigerated orange juices.

The effects of the physicochemical and quality characteristics of various minimally pasteurized refrigerated orange Spanish juices and their changes with storage time and temperature were investigated. Essential oils, acidity, conductivity, diacetyl index, hydroxymethylfurfural, formol index, viscosity and ascorbic acid varied with storage time more significantly at 10 degrees C than at 4 degrees C. Density, colour and pectinmethylesterase did not vary at 4 degrees C. Some of the parameters could be used as indicators of quality loss or spoilage of the juices. The degradation kinetics of the concentration of remaining ascorbic acid against time follows a straight line whose slope indicates the degradation rate. A period of at least 42 days at 4 degrees C and 35 days at 10 degrees C was established as the shelf life of the juices.

Amino Acids↗
PubMed2005

Elevated plasma lactate level associated with high dose inhaled albuterol therapy in acute severe asthma.

BACKGROUND: Lactic acidosis is a recognised event in adult patients with status asthmaticus, particularly in the setting of intensive care. However, it has been infrequently studied in patients attending the emergency departments (ED). METHODS: We conducted a prospective and descriptive study to assess levels of lactate and effects on bronchodilator response in adult patients with acute severe asthma treated with high doses of albuterol in the ED. In total, 18 subjects (mean (SD) age 42.9 (2.7) years, FEV1 = 32.2 (10.9)% of predicted) who presented to an emergency department were enrolled in the study. All patients were treated with albuterol; four puffs (100 microg/puff) at 10 minute intervals, delivered by a pressurised metered dose inhaler into a spacer device over a 2 hour period. RESULTS: At the end of treatment, mean (SD) plasma lactate level (2.94 (2.1) mmol/l) was significantly higher (p = 0.001) than baseline. Of the 18 patients, nine (50%) showed lactate levels > or = 2.5 mmol/l (four patients presented values > 4 mmol/l); these patients had a shorter duration of attack prior to ED presentation (p = 0.01), a higher pretreatment heart rate (p = 0.005), a lower pretreatment SpO2 (p = 0.03), a lower pretreatment PO2 (p = 0.009), a higher pretreatment PCO2, and a lower pretreatment serum potassium (p = 0.005). However, there were no significant differences in the airway response between groups. CONCLUSIONS: This study confirmed previous observations that high lactate concentrations can develop during the first hours of inhaled beta agonist treatment. The presence of a previous hyperadrenergic state may predispose to the development of this condition. A significant improvement in lung function was associated with elevated lactate levels.

Acute Disease↗
PubMed2004

Pneumococcal bacteremia in children: an 8-year review in two hospitals in Barcelona.

In this study, 90 episodes of pneumococcal bacteremia that occurred over an 8-year period in two hospitals in Barcelona were analyzed retrospectively to determine the clinical and bacteriological characteristics of pneumococcal bacteremia, the risk factors for antibiotic resistance, the outcome, and the vaccine coverage. The mean age of the patients was 3.1 years and the male/female ratio was 1.7. The overall rates of penicillin-non-susceptible, cefotaxime-non-susceptible, and erythromycin-resistant isolates were 48.8, 24.4, and 25.5%, respectively. Antibiotic resistance was associated with children under the age of 2 years and with previous antibiotic treatment. The percentage of antibiotic resistance was higher in the nine episodes that occurred in patients with an underlying illness. The most prevalent serotypes identified were 1, 14, 6B, 18C, 5, and 19A. Serotypes 6A/B, 14, and 19A/F were isolated primarily from children under 2, whereas serotypes 1 and 5 were recovered more frequently from older children. Apparent relationships between serotypes 6A/B, 14, and 19A/F and occult bacteremia and between serotypes 1 and 5 and bacteremic pneumonia were confounded by the age variable. The proportion of bacteremic episodes preventable by all (7-valent, 9-valent, and 11-valent) of the conjugate pneumococcal vaccines was 60% in children under 2. In older children, the serotype coverage rate for the three formulations was 48, 87, and 87%, respectively. In summary, these data expand upon previous Spanish studies in which serotypes 1 and 5 were reported to be among the leading causes of severe systemic pneumococcal infections in children over 2, findings that should be taken into consideration when planning vaccine programmes.

Adolescent↗
PubMed2003

Seven-year review of paediatric bacteraemias diagnosed in a Spanish university hospital.

UNLABELLED: This study analysed the clinical and bacteriological patterns of paediatric bacteraemia in a university hospital, by a review of 213 episodes over a period of 7 y. Streptococcus pneumoniae was the most frequent aetiological agent after the neonatal period and Streptococcus agalactiae in neonatal sepsis. Almost half of pneumococci and meningococci were penicillin non-susceptible. Four neonatal deaths attributed to bacteraemia were recorded. CONCLUSION: Streptococcus pneumoniae is the leading cause of community-acquired bacteraemia. Mortality due to bacteraemia in children without underlying conditions is rare.

Academic Medical Centers↗
PubMed2003

Usefulness of urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal pneumonia in children.

We evaluated an immunochromatographic assay detecting pneumococcal antigen in urine samples from children diagnosed with pneumococcal pneumonia. The sensitivity and specificity of the immunochromatographic test with nonconcentrated urine (NCU) were 86.7 and 62.9%, respectively; with concentrated urine (CU), they were 100 and 11.7%, respectively. Pneumococcal antigen was also detected in 42.5% of NCU and 87.1% of CU samples from nasopharyngeal carriers. This is a nonspecific test for the diagnosis of pneumococcal pneumonia in children, particularly the very young.

Adolescent↗
PubMed2002

Heliox for treatment of exacerbations of chronic obstructive pulmonary disease.

BACKGROUND: Due to its low density properties, helium-oxygen mixtures have the potential to decrease the work of breathing and possibly avoid the need for intubation and mechanical ventilation in patients with respiratory failure. OBJECTIVES: To determine the effect of the addition of helium/oxygen mixtures (heliox) to standard medical care during ventilated and nonventilated acute exacerbations of COPD. SEARCH STRATEGY: Randomized controlled trials were identified from the Cochrane Airways Review Group asthma Register. Primary authors and experts were contacted. References from included and excluded studies, known reviews and texts were also searched. SELECTION CRITERIA: Studies were selected for inclusion if they compared treatment with heliox to placebo (oxygen or air) in randomized controlled trials in adults with an exacerbation of COPD. DATA COLLECTION AND ANALYSIS: Data from all trials were combined using the Review Manager (version 4.1). We planned to perform: 1) random effects weighted mean difference (WMD), with 95% confidence intervals (95% CI), 2) Homogeneity of effect sizes with the Dersimonian and Laird method with p<0.1 as the cut point for significance, and 3) sensitivity analysis on different helium-oxygen mixtures (80/20 vs 70/30), and 4) methodological quality (Jadad score >2 vs. <3). MAIN RESULTS: Four studies, all published between 1997 and 2000 met the inclusion criteria. Two studies compared heliox-oxygen vs. air-oxygen in decompensated COPD patients who were not ventilated. One study was performed in mechanical ventilated patients and one in patients undergoing noninvasive pressure support (NIPSV) ventilated patients. Data could be obtained for only two of the studies. One was a randomized crossover study of 70:30 helium-oxygen vs air-oxygen that involved nineteen patients with acute severe COPD, hospitalized in an intensive care unit for NIPSV. In the patients receiving heliox, arterial PCO2 fell more; WMD 0.8 kPa (95% CI 0.26, -1.34). The second was a randomized trial involved 47 patients with acute COPD, who presented to an Emergency Department randomized to receive updraft nebulization of albuterol and ipratropium bromide using 80% helium and 20% oxygen or compressed air as the driving gas. Treatments were administered at 0, 20, 40, and 120 minutes after randomization. There were no significant differences in the change of FEV1 and FVC between the two groups by either the 1 or 2 hours point. although a small improvement in FEF 25-75 was significantly greater in the heliox group than in the air group. REVIEWER'S CONCLUSIONS: There is currently insufficient evidence to support the use of helium-oxygen mixtures to treat acute exacerbations of COPD in either ventilated or nonventilated patients. Suitably designed randomised controlled trials with the endpoint being the avoidance of mechanical ventilation may be justified.

Helium↗
PubMed2001

Helium-oxygen mixture for nonintubated acute asthma patients.

BACKGROUND: Helium and oxygen mixtures (heliox), have been used sporadically in respiratory medicine for decades. Their use in acute respiratory emergencies such as asthma has been the subject of considerable debate. Despite the lapse of more than 60 years since it was first proposed, the role of heliox in treating patients with acute severe asthma is unclear. OBJECTIVES: To determine the effect of the addition of heliox to standard medical care on the course of acute asthma, as measured by pulmonary function testing and clinical endpoints. SEARCH STRATEGY: Randomized controlled trials were identified from the Cochrane Airways Group Asthma Register which is a compilation of systematic searches of CINAHL, EMBASE, MEDLINE, and CENTRAL and hand searching of the 20 most productive respiratory care journals. In addition, primary authors and experts were contacted to identify eligible studies. References from included studies, known reviews and texts were also searched. SELECTION CRITERIA: Inclusion criteria were: 1) randomized, single or double blind, controlled trials; 2) children or adults with a clinical diagnosis of acute asthma seen in emergency departments or equivalent acute care settings; 3) compared treatment with inhaled heliox compared with a control (oxygen or air). Two reviewers independently assessed the studies for inclusion and quality assessment; disagreement was resolved by a third reviewer and consensus. DATA COLLECTION AND ANALYSIS: Data from all included trials were combined using weighted mean differences (WMD), with 95% confidence intervals (95% CI) in a random effects model. Homogeneity of effect sizes were tested with the Dersimonian and Laird method with p<0.1 as the cut point for significance. Sensitivity analyses were performed on age (adults vs. children), different helium-oxygen mixtures and methodological quality. MAIN RESULTS: A total of 4 randomized controlled trials were selected for inclusion with a total of 288 acute asthma patients. Three studies involved adults and one study dealt solely with children. Two were of low quality. The main outcome variable was spirometric measurements (PFT % predicted) in all trials. Pooling the four trials showed no significant differences (WMD = -1.61; 95% CI: -6.64 to 3.41). All pulmonary function tests were recorded during heliox administration (15 to 60 min). There was no evidence of heterogeneity between studies. There were no significant differences between groups when adults vs. children, high vs. low quality, and high vs. low heliox dose studies were compared. The findings were the with a fixed effects model. REVIEWER'S CONCLUSIONS: The existing evidence does not provide support for the administration of helium-oxygen mixtures to patients presenting to the emergency department with moderate to severe acute asthma. Heliox treatment does not have a role in the initial treatment of patients with acute asthma. These conclusions are based upon between-group comparisons and small studies. Additional research in this setting may be warranted.

Acute Disease↗
PubMed2000

Efficacy of magnesium sulfate in acute adult asthma: a meta-analysis of randomized trials.

The purpose of this article was to review of the literature to determine whether MgSO4 provides an additive improvement in adults with acute asthma in the emergency department (ED). English-language published and unpublished studies (1968-1998) were retrieved using MEDLINE, SCIENCE CITATION INDEX, CURRENT CONTENTS, bibliographic reviews of primary research, review articles, consultation with experts, and the register of Medical Editors' Trial Amnesty. Meta-analysis of randomized, placebo controlled trials. The five selected trials included 374 patients with acute asthma (mean age 38.3 +/- 13.4 years, 30% men, 70% women). The main outcome measure was pulmonary function; admission rate was evaluated as a secondary goal. Individual and pooled effect sizes (ES) were determined for pulmonary function data. Binary outcome (admission rate) was combined and reported as odds ratio (OR). The overall summary ES (95% confidence interval [CI]) of the five trials satisfying all inclusion criteria, weighted by sample size was nonsignificant (ES = 0.02, -0.20 to 0.24, P = .84). This pooled ES was equivalent to 1.7%, 95% CI: -9.8 to 13.1%) greater in pulmonary function the MgSO4 compared with the control group. On the other hand, four studies addressed the effect of MgSO4 administration on hospital admissions. Pooled results revealed that MgSO4 did not decrease significantly admission rates (OR = 0.68, 95% CI: 0.41 to 1.15). The existing evidence reveals that the addition of MgSO4 to ED patients with moderate to severe asthmatic exacerbations does not alter treatment outcomes. Nevertheless, the number and size of studies being pooled remain small.

Acute Disease↗