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      Encuesta sobre la actividad de los laboratorios de función pulmonar. Efectos durante la pandemia por SARS-CoV-2 Translated title: National Survey on the Activity of Lung Function Laboratories. Effects During the SARS-COV-2 Pandemic

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          Abstract

          Introducción

          A raíz de la pandemia de SARS-CoV-2 en marzo del 2020 los laboratorios de función pulmonar (LFP) sufrieron una transformación, con la reducción del número de pruebas o cierre en algunos casos. El objetivo de este trabajo fue conocer la actividad de los LFP en España y la modificación de esta debido a la pandemia.

          Material y métodos

          Se realizó una encuesta protocolizada a los miembros de los LFP a través de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR).

          Resultados

          Contestaron 39 hospitales del territorio nacional. Las pruebas de función pulmonar que más se realizaban en los LFP fueron: espirometría forzada con prueba broncodilatadora (100%), pletismografía corporal (97,4%), capacidad de transferencia CO (97,4%), fuerza de los músculos respiratorios medidos en boca (97,4%), prueba de la marcha de 6 min (94,7%), medición de fracción exhalada de óxido nítrico (92,3%) y prueba de esfuerzo incremental (71,8%).

          La pandemia produjo un descenso significativo en el número de pruebas (35,4%) durante el 2020 con posterior recuperación en el 2021, sin llegar a valores prepandemia.

          Los cambios más importantes fueron: incremento en los tiempos de exploración, el trabajo con equipos de protección individual y la ventilación de los espacios. La realización del frotis nasofaríngeo para estudio de SARS-CoV-2 previo a las pruebas no fue homogénea en los LFP.

          Conclusiones

          La mayoría de los hospitales disponen del equipamiento suficiente para la realización de las pruebas de función pulmonar más frecuentes. La pandemia supuso una pérdida de actividad en todos los hospitales.

          Translated abstract

          Introduction

          Following the SARS-CoV-2 pandemic in March 2020, pulmonary function testing (PFT) laboratories underwent a transformation, with a reduction in the number of tests or closure in some cases. The aim of this work was to know the activity of PFT in Spain and the modification of this activity due to the pandemic.

          Material and methods

          A protocolised survey was carried out to members of the PFT laboratories through the Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

          Results

          Thirty-nine hospitals in Spain responded. The pulmonary function tests most frequently performed in the PFT laboratories were forced spirometry with bronchodilator test (100%), body plethysmography (97.4%), CO transfer capacity (97.4%), respiratory muscle strength measured in the mouth (97.4%), 6-minute walking test (94.7%), measurement of exhaled fraction of nitric oxide (92.3%) and incremental exercise test (71.8%).

          The pandemic led to a significant decrease in the number of tests (35.4%) during 2020 with subsequent recovery in 2021, without reaching pre-pandemic values.

          The most important changes were increased examination times, working with personal protective equipment and ventilation of the rooms. The performance of the nasopharyngeal swab for SARS-CoV2 testing prior to the tests was not homogeneous in the PFT laboratories.

          Conclusions

          Most hospitals are sufficiently equipped to perform the most common pulmonary function tests. The pandemic resulted in a loss of activity in all hospitals.

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          Most cited references9

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          Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations.

          The aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5-95 yrs. Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family. After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3-95 yrs for Caucasians (n=57,395), African-Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV(1)) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV(1)/FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed. Spirometric prediction equations for the 3-95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future.
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            Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis

            Background Evidence suggests lungs as the organ most affected by coronavirus disease 2019 (COVID-19). The literature on previous coronavirus infections reports that patients may experience persistent impairment in respiratory function after being discharged. Our objective was to determine the prevalence of restrictive pattern, obstructive pattern and altered diffusion in patients post-COVID-19 infection and to describe the different evaluations of respiratory function used with these patients. Methods A systematic review was conducted in five databases. Studies that used lung function testing to assess post-infection COVID-19 patients were included for review. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results Of the 1,973 reports returned by the initial search, seven articles reporting on 380 patients were included in the data synthesis. In the sensitivity analysis, we found a prevalence of 0.39 (CI 0.24–0.56, p < 0.01, I2 = 86%), 0.15 (CI 0.09–0.22, p = 0.03, I2 = 59%), and 0.07 (CI 0.04–0.11, p = 0.31, I2 = 16%) for altered diffusion capacity of the lungs for carbon monoxide (DLCO), restrictive pattern and obstructive pattern, respectively. Conclusion Post-infection COVID-19 patients showed impaired lung function; the most important of the PFTs affected was the diffusion capacity.
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              COVID-19 pandemic and non invasive respiratory management: every Goliath needs a David. An evidence based evaluation of problems.

              Background and aim The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. Methods We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and reviewed the references of retrieved articles for additional studies. The search was limited to the terms: Covid-19 AND: acute respiratory distress syndrome (ARDS), SARS, MERS, non invasive ventilation (NIV), high flow nasal cannula (HFNC), pronation (PP), health care workers (HCW). Results Protection of Health care workers should be paramount, so full Personal Protective Equipment and Negative pressure rooms are warranted. HFNC alone or with PP could be offered for mild cases (PaO2/FiO2 between 200-300); NIV alone or with PP may work in moderate cases (PaO2/FiO2 between 100-200). Rotation and coupled (HFNC/NIV) strategy can be beneficial. A window of opportunity of 1-2 hours is advised. If PaO2/FIO2 significantly increases, Respiratory Rate decreases with a relatively low Exhaled Tidal Volume, the non-invasive strategy could be working and intubation delayed. Conclusion Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients and HCW. Indirectly, non invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.
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                Author and article information

                Contributors
                Twitter Icon
                Journal
                Open Respir Arch
                Open Respir Arch
                Open Respiratory Archives
                Elsevier
                2659-6636
                16 March 2024
                Apr-Jun 2024
                16 March 2024
                : 6
                : 2
                : 100315
                Affiliations
                [a ]Servicio de Neumología, Parc Taulí Hospital Universitari, Insitut d’ Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
                [b ]Servicio de Neumología, Hospital del Mar, Barcelona, CEXS, Universitat Pompeu Fabra, Barcelona, CIBER de Enfermedades Respiratorias (CIBERES), ISC III, Madrid, España
                [c ]Servicio de Neumología, Hospital Germans Tries i Pujol, Badalona, Barcelona, España
                [d ]Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
                [e ]Servicio de Neumología, Hospital Virgen del Rocío, Sevilla, España
                [f ]Servicio de Neumología, Hospital Universitario Gregorio Marañón, Madrid, España
                Author notes
                [* ]Autor para correspondencia. lvigil@ 123456tauli.cat Twitter Icon
                [◊]

                En el anexo 1 figuran los colaboradores del grupo de trabajo por orden alfabético.

                Article
                S2659-6636(24)00018-3 100315
                10.1016/j.opresp.2024.100315
                11021358
                38633621
                1d67aa38-3317-4beb-806b-1346f0494132
                © 2024 Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Published by Elsevier España, S.L.U.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 8 January 2024
                : 29 February 2024
                Categories
                Original

                laboratorio de función pulmonar,espirometría,prueba de esfuerzo,virus sars-cov-2,pandemia,covid,pulmonary function testing laboratory,spirometry,cardiopulmonary exercise test,sars-cov-2 virus,pandemic

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