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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "127" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Navarro Esteva, Antonio M. Esquinas Rodríguez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Javier" "apellidos" => "Navarro Esteva" "email" => array:1 [ 0 => "jnesteva7@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Antonio M." "apellidos" => "Esquinas Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Agudización grave de asma en una unidad de cuidados respiratorios intermedios: ¿realidad o controversia?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The development of respiratory intermediate care units (RICUs) has allowed for better care of patients with acute respiratory failure (ARF) of diverse etiology.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> RICUs are beneficial for patients requiring noninvasive ventilation (NIV). In the case of severe asthma exacerbations (SAE), the use of NIV remains controversial.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We read with interest the original study by Núñez et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> analyzing the progress of patients with SAE at an RICU. This important contribution highlights the importance of these units. However, in our opinion, there are some aspects of this study that need to be clarified.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A. In the selection of patients, the date of diagnosis, reversibility of bronchial obstruction, family history, and other features supporting diagnosis are unknown. Among SAE patients admitted to RICU, 37% were active smokers or former smokers. Furthermore, of the ten patients receiving NIV, five were obese and three had kyphoscoliosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This gives rise to the following questions: How many patients had asthma? How many had COPD and not asthma? NIV can be effective, even in patients with COPD and pneumonia (the most frequent finding in RICU patients). This leads us to wonder whether the patients with kyphoscoliosis and obesity had chronic hypoventilation and whether they could have benefited from NIV.</p><p id="par0025" class="elsevierStylePara elsevierViewall">B. Regarding the definition of SAE, according to the GINA guidelines, patients with severe asthma flare-up can have a peak flow of <60% of the known or theoretical maximum value, or else <100<span class="elsevierStyleHsp" style=""></span>l/min and/or PaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mmHg.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The average peak flow in RICU patients is substantially greater, so airflow limitation might not be the most influential factor in the blood-gas deterioration. The physical examination parameters suggested by the GINA guidelines – alertness, use of accessory muscles, respiratory and heart rate, etc. – have not been reported.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A description of the authors’ recommendations on the criteria for RICU admission would be interesting. Might SAE patients benefit from RICU monitoring, whether they receive NIV or not? We believe that if the previous recommendations are met, the answer is yes, and in this way prompt attention can be guaranteed, if necessary.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In any case, this study does not allow conclusions to be drawn on the effect of NIV in patients with SAE, although we accept that this is not its purpose. Studies of NIV in SAE have been carried out in emergency departments. The use of NIV has been associated with an improvement in lung function and respiratory mechanics, but no changes have been observed in hospitalization or intubation rates. These objectives should be included in future studies, and appropriate selection criteria and methodology – mode and ventilation parameters, interface type, hours of ventilation, aerosol methodology, etc. – should be employed.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to economic aspects, we agree that RICUs are cost-effective, but, again, the methodology of this study limits conclusions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro Esteva J, Esquinas Rodríguez AM. Agudización grave de asma en una unidad de cuidados respiratorios intermedios: ¿realidad o controversia? Arch Bronconeumol. 2014;50:127.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory high-dependency care units for the burden of acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. 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Ferrer" 2 => "J.B. Blanquer" 3 => "M. Calle" 4 => "V. Casolivé" 5 => "J.M. Echave" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "505" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16194514" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000003/v1_201403120155/S1579212914000342/v1_201403120155/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000003/v1_201403120155/S1579212914000342/v1_201403120155/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914000342?idApp=UINPBA00003Z" ]
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