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Biomedical subjects

J Escarrabill

Publications and source records attributed to J Escarrabill.

At least 19 recordsLinked to original sources
PubMed1998

Long-term mechanical ventilation in amyotrophic lateral sclerosis.

BACKGROUND: Acute respiratory insufficiency (ARI) with alveolar hypoventilation or incapacitating dyspnoea but without peripheral muscle involvement can be an early manifestation of respiratory involvement in amyotrophic lateral sclerosis (ALS). Some of these patients benefit from assisted ventilation. The object of this study was to analyse the results of long-term mechanical ventilation (LTMV) in ten patients with ALS. METHODS: A retrospective analysis of intensive care unit (ICU) or ambulant patients with ALS who underwent LTMV in a conventional hospital ward was performed. Erect and supine spirometry, blood gas analysis and pulse oximetry were performed before the start and during the course of ventilation. RESULTS: Ten patients on LTMV were included. Four from the ICU were ventilated via tracheostomy, and six ambulant patients had non-invasive (nasal) ventilation. In all cases, ventilation was performed in a conventional hospital ward. The ambulant patients improved symptomatically during ventilation, confirmed by measurement of gas exchange and of SaO2 by continuous pulse oximetry. Three of the ten patients survive in long-term care--two with nasal and one with tracheostomy ventilation. CONCLUSIONS: LTMV outside ICU was possible in ten patients, seven of whom returned home. Returning home is very difficult for patients dependent on a ventilator who lack family support.

Amyotrophic Lateral Sclerosis↗
PubMed1998

Transtracheal catheter acceptance and adverse events in long-term home oxygen therapy.

The acceptance of transtracheal catheters (TTC) in chronic obstructive pulmonary disease (COPD) patients with severe hypoxaemia was analysed and the adverse events associated with this system of oxygenation described. Once the TTC (Oxycat) was inserted, each patient was monitored on an outpatient basis and information about the associated adverse events was collected. In a group of 70 patients that met the inclusion criteria, only 14 (20%) accepted TTC insertion. The observed adverse events were: haemorrhage through the stoma (3); ejection of the TTC in a cough reflex (2); subcutaneous emphysema (2); mucous plugging (1); and haemoptysis (1). Removal of the TTC was necessary in 29% of the cases, and was associated with the onset of an adverse event in all cases except one. Despite the proven benefits of oxygen therapy performance and the improvement in effort tolerance, transtracheal catheter has a low level of acceptance among patients with extremely disabling diseases. The adverse events observed were frequent, but could have been corrected and in no case worsened our patients' prognosis.

Aged↗
PubMed1997

The importance of process variables analysis in the assessment of long-term oxygen therapy by concentrator.

The aim of the present study was to evaluate process variables and intermediate outcomes involved in long-term oxygen therapy (LTOT) by concentrator with the purpose of identifying which of those factors would be the most influential in the final health outcome of the therapy. A cross-sectional survey was carried out on a random sample of 111 patients receiving LTOT by concentrator in Catalonia (Spain). Patients were interviewed and assessed at home by a trained physician, and the variables collected were arterial oxygen saturation, performance of the concentrators, and patient compliance. Sixty-two patients participated in the study. Overall, LTOT was appropriately prescribed in 36 patients, of whom only 29 were able to correct their level of hypoxaemia. Patient compliance with treatment was considered adequate in 19 of those 29 patients. Thus, only 19 of 62 patients (31%) fulfilled those criteria needed to achieve the expected clinical benefits. Strategies for improving the effectiveness of medical interventions or technologies ought to consider those factors of the therapeutic process which might influence the expected health outcomes in a specific health-care context.

Aged↗
PubMed1996

[Appropriate use and effectiveness of chronic domiciliary oxygen therapy in Catalonia].

BACKGROUND: The aim of this study was to study the pattern of the use of chronic domiciliary oxigenotherapy (CDO) in Catalonia, Spain. METHODS: A transversal study including 110 patients randomly selected from a list of all the subjects with CDO (n = 3,585) was made. A domiciliary survey on the characteristics of the indication for CDO and its fulfillment was carried out. Two pulsioximetries were also performed one breathing room air and another with oxigen. RESULTS: Of the 70 eligible patients the following factors were simultaneously observed in only 14 (20% of the total): adequate indication for CDO, use of oxigen at a flow which corrected the hypoxemia, and prescription fulfillment. The most important cause of inadequate usage of CDO was inappropriate indication since only 19 patients (27%) presented SaO2 less than or equal to 88%. Hypoxemia was not corrected in four of these 19 patients. Thirty-seven percent of the total admitted bad fulfillment, bot only one of the 15 patients with SaO2 less than or equal to 88% and in whom hypoxemia was corrected, recognized bad fulfillment. Sixty-nine percent of the patients had a document explaining the way and length of time they should receive the oxigen. CONCLUSIONS: The inappropriate indication of CDO is the main factor influencing the low effectiveness of chronic domiciliary oxigenotherapy in Catalonia.

Aged↗
PubMed1992

[The evaluation of the oxygen-conserving valve during exertion].

BACKGROUND: The oxygen-conserving valve (OCV) permits reduction in oxygen consumption upon the release of oxygen only during inhalation thereby increasing the autonomy of portable sources. METHODS: In order to confirm its efficacy during exercise, 15 patients with chronic limitation of air flow and gasometric criteria of domiciliary oxygen therapy were selected. The patients underwent three walking tests (WT) of 6 minutes during which the continuous form of transcutaneous hemoglobin saturation (SaO2) and the distance covered were registered. The first was carried out breathing synthetic air at a flow of 2 liters per minute; the second with continuous oxygen released by a portable source at 2 liters per minute and the third with the OCV coupled to a portable source at the same flow. RESULTS: SaO2 reached with the continuous oxygen is significantly higher to that of synthetic air while there was no difference between the SaO2 with continuous oxygen and with valve. Improvement in SaO2 upon use the valve was not obtained in only 2 of the 15 patients. A significant increase was observed in the distance covered upon oxygen administration not only in the continuous form but also with OCV with respect to synthetic air. CONCLUSIONS: OCV is as effective as continuous oxygen in the correction of desaturation during exercise, however its indications must be individualized by exercise tests (WT) in each patients in order to ensure its correct functioning.

Adult↗
PubMed1992

[Effectiveness of the concentrator as a supply source in home oxygen therapy].

The oxygen concentrator is an effective supply source in home oxygen-therapy (HO). In order to study the effectivity of the concentrator in HO, we visited at home 31 patients using the concentrator as the only oxygen supply source in the exit gas and counted the hours of concentrator usage. Only 13 concentrators (41.9%) supplied a percentage of oxygen higher than 87% at a flow of two liters per minute. In three cases (9.7%), sporadic control measures of the percentage of oxygen in the exit gas were being taken and only four patients (12.9%) said that these controls were made monthly. The concentrator did not supply the adequate percentage of oxygen in 12 out of the 29 patients correctly taking the HO, so the effectivity of the treatment can only be expected in 28.6% of studied cases. The concentrator operates well under ideal conditions, but potential breakdowns in standard conditions of use must be considered. The efficiency of the HO with concentrator in our environment is very low, but it can be improved with regular controls of the concentrators or the introduction of devices warning the patient when they detect a reduction of the percentage of oxygen in the exit gas.

Aged↗
PubMed1991

[Long-term effects of home mechanical ventilation with positive pressure using a nasal mask].

Home mechanical ventilation (HMV) is an efficient alternative in the treatment of patients with chronic respiratory failure secondary to restrictive mechanical disorders (neuromuscular disease, such as Duchenne's disease, thorax deformities due to kyphoscoliosis or tuberculosis sequelae). The case of a patient with severe kyphoscoliosis in the phase of chronic respiratory failure (PaO2 34 mmHg and PaCO2 61 mmHg, breathing ambient air) is presented in which, following the failure of negative pressure mechanical ventilation ("poncho"), positive pressure ventilation was tested with a silicon made-to-measure nasal mask as the access via. Adaptation to HMV was good with the patient using the ventilation nightly. Following 12 months of treatment the patient is able to carry out everyday activities and arterial gasometry breathing ambient air is PaO2 77 mmHg and PaCO2 43 mmHg.

Female↗
PubMed1990

[The introduction of liquid oxygen as a portable source in continuous home oxygen therapy].

The most widespread types of oxygen delivery at home in our area are bottles where the gas is stored under pressure and concentrators. Both devices can only be used at rest. We have assessed a new system for the delivery of liquid oxygen to be used at home, provided with a portable unit which permits that the patients receive oxygen also outside their homes. Seven such devices have been implemented in the Barcelona area, with an excellent acceptance and without technical problems. To verify the clinical indication, exercise tests were carried out both in baseline conditions and receiving oxygen from the portable source. Oxyhemoglobin saturation and the walked distance were continuously measured. In all patients important drops in the saturation of oxyhemoglobin were recorded during walking, which was corrected with oxygen administration. Liquid oxygen with a portable source is a good delivery system for oxygen therapy at home, permitting to receive oxygen throughout the day, particularly during exercise. Although the availability of liquid oxygen is limited, it should be recommended to the patients in whom exercise hypoxemia is shown to be corrected and who desire an active social life.

Drug Storage↗
PubMed1990

[Survey of the attitude of primary care physicians towards AIDS].

A representative group of primary care physicians from Areas 4 and 5 of the Institut Català de la Salut were surveyed in orden to know their opinion about the spreading of HIV infection, the value of serological tests and the methods to prevent the infection of health care providers. More than half of the physicians (58.5%) had never been in contact with an HIV infected patient. Of the surveyed physicians, 47.2% believe that it is necessary to spread out more information on preventive measures amongst health professionals. 48.4% believe that confidentiality is important but only 16.9% consider it is important to obtain an informed consent to perform serological testing and another 22.5% mainly trust systematic serological testing. Primary care can play an important role avoiding the spread of HIV infection and, in fact, the importance of preventive measures and confidentiality are assumed by an elevated percentage of health professionals. The usefulness of serological testing, however, is not properly assessed valued and little importance is granted to the patient's consent for their performance.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[The tobacco habit in patients using home oxygen therapy].

The persistence of smoking habits results in a worse prognosis of patients with chronic airflow limitation. Some authors consider that oxygen therapy at home (OTH) is meaningless if the patient does not give up smoking. To assess the number of smokers in a group of 65 patients on OTH, a questionnaire on smoking habits was administered and the CO concentration in the expired air was measured. 27.7% of the study patients smoked; 12.3% admitted that they smoked on being questioned and the remaining 15.4% were identified by CO concentrations in the expired air equal to or higher than 10 ppm. There were no significant differences between the groups of smokers and nonsmokers regarding age and pulmonary function, but the rate of those declaring a poor compliance with OTH was higher among smokers.

Aged↗