Relación del flujo espiratorio máximo con la exploración clínica y la gasometría arterial en la valoración de gravedad de la crisis asmática
Relation of peak expiratory flow to clinical findings and arterial gasometry readings used to assess severity of asthma attack
Servicio de Neumología. Hospital Universitario La Fe. Valencia
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Martínez Francés, P. Cordero Rodríguez, M. Perpiñá Tordera" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "León Fábregas" ] 1 => array:3 [ "nombre" => "A." "apellidos" => "de Diego Damiá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Martínez Francés" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Cordero Rodríguez" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Perpiñá Tordera" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología. Hospital Universitario La Fe. Valencia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Servicio de Neumología. Hospital Universitario La Fe. Avda. Campanar, 21. 46009 Valencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Relation of peak expiratory flow to clinical findings and arterial gasometry readings used to assess severity of asthma attack" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1995-03-21" "fechaAceptado" => "1995-07-04" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec546063" "palabras" => array:3 [ 0 => "Gravedad de la crisis asmática" 1 => "Flujo espiratorio máximo" 2 => "Gasometría arterial" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec546064" "palabras" => array:4 [ 0 => "Asthma" 1 => "Severity of attack" 2 => "Peak expiratory flow" 3 => "Arterial gasometry" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los protocolos de tratamiento de la agudización asmática utilizan en la actualidad la medición del flujo espiratorio máximo (FEM) para orientar el tratamiento y valorar la evolución del paciente. El empleo de otros parámetros clínicos o funcionales ha sido señalado también en la valoración de gravedad de la crisis. Con objeto de investigar la utilidad de estos criterios hemos analizado su relación con el grado de obstrucción al flujo aéreo, expresado por el FEM, en una muestra de 48 pacientes asmáticos que acudieron a urgencias por exacerbación de su enfermedad, excluyendo a seis de ellos por presentar riesgo vital inminente en el momento de su admisión. Entre los parámetros clínicos analizados, sólo la presencia de cianosis o diaforesis guardó relación con el grado de obstrucción; la utilización de la musculatura accesoria o constantes vitales como la frecuencia cardíaca, respiratoria o la tensión arterial eran similares en pacientes con exacerbación grave (FEM < 50%) o sin ella (FEM > 50%). En la gasometría arterial, únicamente la PaO<span class="elsevierStyleInf">2</span> era significativamente inferior en los pacientes con FEM < 50%. La relación entre ambos parámetros permitió identificar un punto de corte que separaba los pacientes que presentaban insuficiencia respiratoria; según este punto, cuando el valor inicial del FEM se situaba por encima del 50% del valor teórico ningún paciente tenía una Pa0<span class="elsevierStyleInf">2</span> < 60 mmHg. Concluimos: <span class="elsevierStyleItalic">1)</span> los parámetros clínicos no siempre guardan relación con la gravedad de la crisis establecida según el grado de obstrucción al flujo aéreo, y <span class="elsevierStyleItalic">2)</span> un valor del FEM > 50% al inicio de la exacerbación asmática permite descartar la presencia de insuficiencia respiratoria y hace innecesaria la realización de la gasometría arterial.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Protocols for treating acute asthma presently rely on measurement of peak expiratory flow (PEF) to orient treatment and evaluate progress. Other clinical or functional parameters have also been considered for use in the assessment of severity of attack. In order to investígate the usefulness of these criteria we analyzed their relation to degree of air flow obstruction expressed by PEF in a sample of 48 asthmatics who carne to the emergency room for treatment of disease exacerbation, excluding 6 who presented imminent risk of death at the time of admission. Among the clinical parameters analyzed, only presentation of cyanosis or diaphoresis was related to degree of obstruction. The pattern of accessory muscle use or vital signs such as heart, breathing rate or blood pressure were similar in patients with (PEF < 50%) or without (PEF > 50%) severe exacerbation. Among gasometric readings only PaO<span class="elsevierStyleInf">2</span> was significantly lower in patients with PEF < 50% and we were able to identify a cutoff point useful as a screen for respiratory insufficiency: when the initial PEF was above 50% of theoretical valué, no patient had PaO<span class="elsevierStyleInf">2</span>, < 60 mmHg. We conclude that: <span class="elsevierStyleItalic">1)</span> clinical parameters do not always reflect severity of attack established by degree of air flow obstruction, and <span class="elsevierStyleItalic">2)</span> PEF > 50% at the start of asthmatic exacerbation allows respiratory insufficiency to be ruled out, making performance of gasometric measurement unnecessary.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frecuentación del paciente con asma agudizada a la urgencia hospitalaria de tercer nivel" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 44 | 21 | 65 |
| 2024 September | 37 | 16 | 53 |
| 2024 August | 49 | 32 | 81 |
| 2024 July | 44 | 25 | 69 |
| 2024 June | 67 | 25 | 92 |
| 2024 May | 48 | 38 | 86 |
| 2024 April | 30 | 24 | 54 |
| 2024 March | 40 | 31 | 71 |
| 2024 February | 26 | 36 | 62 |
| 2024 January | 0 | 6 | 6 |
| 2023 December | 0 | 1 | 1 |
| 2023 November | 0 | 1 | 1 |
| 2023 October | 0 | 2 | 2 |
| 2023 September | 0 | 3 | 3 |
| 2023 July | 0 | 20 | 20 |
| 2023 June | 0 | 3 | 3 |
| 2023 March | 4 | 2 | 6 |
| 2023 February | 28 | 18 | 46 |
| 2023 January | 21 | 28 | 49 |
| 2022 December | 43 | 26 | 69 |
| 2022 November | 37 | 20 | 57 |
| 2022 October | 31 | 21 | 52 |
| 2022 September | 30 | 27 | 57 |
| 2022 August | 40 | 38 | 78 |
| 2022 July | 27 | 36 | 63 |
| 2022 June | 29 | 30 | 59 |
| 2022 May | 36 | 27 | 63 |
| 2022 April | 33 | 31 | 64 |
| 2022 March | 36 | 39 | 75 |
| 2022 February | 30 | 27 | 57 |
| 2022 January | 27 | 31 | 58 |
| 2021 December | 25 | 36 | 61 |
| 2021 November | 20 | 40 | 60 |
| 2021 October | 55 | 28 | 83 |
| 2021 September | 20 | 49 | 69 |
| 2021 August | 13 | 34 | 47 |
| 2021 July | 19 | 24 | 43 |
| 2021 June | 18 | 44 | 62 |
| 2021 May | 17 | 28 | 45 |
| 2021 April | 70 | 118 | 188 |
| 2021 March | 42 | 29 | 71 |
| 2021 February | 48 | 35 | 83 |
| 2021 January | 29 | 33 | 62 |
| 2020 December | 22 | 16 | 38 |
| 2020 November | 8 | 12 | 20 |
| 2020 October | 12 | 5 | 17 |
| 2020 September | 18 | 15 | 33 |
| 2020 August | 14 | 17 | 31 |
| 2020 July | 15 | 16 | 31 |
| 2020 June | 16 | 11 | 27 |
| 2020 May | 15 | 19 | 34 |
| 2020 April | 26 | 16 | 42 |
| 2020 March | 22 | 17 | 39 |
| 2020 February | 25 | 30 | 55 |
| 2020 January | 37 | 29 | 66 |
| 2019 December | 34 | 29 | 63 |
| 2019 November | 19 | 15 | 34 |
| 2019 October | 11 | 23 | 34 |
| 2019 September | 12 | 27 | 39 |
| 2019 August | 12 | 11 | 23 |
| 2019 July | 15 | 29 | 44 |
| 2019 June | 12 | 23 | 35 |
| 2019 May | 11 | 20 | 31 |
| 2019 April | 14 | 27 | 41 |
| 2019 March | 6 | 24 | 30 |
| 2019 February | 7 | 19 | 26 |
| 2019 January | 5 | 13 | 18 |
| 2018 December | 6 | 16 | 22 |
| 2018 November | 16 | 17 | 33 |
| 2018 October | 24 | 17 | 41 |
| 2018 September | 18 | 6 | 24 |
| 2018 May | 7 | 2 | 9 |
| 2018 April | 5 | 7 | 12 |
| 2018 March | 6 | 6 | 12 |
| 2018 February | 7 | 14 | 21 |
| 2018 January | 6 | 7 | 13 |
| 2017 December | 5 | 9 | 14 |
| 2017 November | 13 | 16 | 29 |
| 2017 October | 8 | 22 | 30 |
| 2017 September | 2 | 10 | 12 |
| 2017 August | 9 | 15 | 24 |
| 2017 July | 5 | 21 | 26 |
| 2017 June | 9 | 24 | 33 |
| 2017 May | 11 | 19 | 30 |
| 2017 April | 9 | 15 | 24 |
| 2017 March | 5 | 12 | 17 |
| 2017 February | 4 | 11 | 15 |
| 2017 January | 3 | 5 | 8 |
| 2016 December | 12 | 6 | 18 |
| 2016 November | 24 | 14 | 38 |
| 2016 October | 23 | 16 | 39 |
| 2016 September | 11 | 10 | 21 |
| 2016 August | 16 | 4 | 20 |
| 2016 July | 17 | 5 | 22 |
| 2016 June | 20 | 8 | 28 |
| 2016 May | 12 | 7 | 19 |
| 2016 April | 7 | 0 | 7 |
| 2016 March | 7 | 0 | 7 |
| 2016 February | 14 | 2 | 16 |
| 2016 January | 24 | 7 | 31 |
| 2015 December | 33 | 19 | 52 |
| 2015 November | 26 | 7 | 33 |
| 2015 October | 9 | 2 | 11 |
| 2015 September | 3 | 0 | 3 |
| 2015 June | 1 | 0 | 1 |
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