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The use of sedatives in Intensive Care Units (ICU) is essential for relieving anxiety and stress in mechanically ventilated patients, and it is related to clinical outcomes, duration of mechanical ventilation, and length of stay in the ICU. Inhaled sedatives offer benefits such as faster awakening and extubation, decreased total opioid and neuromuscular blocking agents (NMB) doses, as well as bronchodilator, anticonvulsant, and cardiopulmonary and neurological protective effects. Inhaled sedation is administered using a specific vaporizer. Isoflurane is the recommended agent due to its efficacy and safety profile. Inhaled sedation is recommended for moderate and deep sedation, prolonged sedation, difficult sedation, patients with acute respiratory distress syndrome (ARDS), status asthmaticus, and super-refractory status epilepticus. By offering these significant advantages, the use of inhaled sedatives allows for a personalized and controlled approach to optimize sedation in the ICU., (Copyright © 2024 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Introduction: The present study describes our experience with the high-flow humidified nasal cannula (HFNC) versus non-invasive ventilation (NIV) in children with severe acute asthma exacerbation (SA)., Methods: An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit (PICU) for non-invasive respiratory support was made. The primary outcome measure was failure of initial respiratory support (need to escalate from HFNC to NIV or from NIV to invasive ventilation). Secondary outcome measures were the duration of respiratory support and PICU length of stay (LOS)., Results: Forty-two children met the inclusion criteria. Twenty (47.6%) received HFNC and 22 (52.3%) NIV as initial respiratory support. There were no treatment failures in the NIV group. However, 8 children (40%) in the HFNC group required escalation to NIV. The PICU LOS was similar in both the NIV and HFNC groups. However, on considering the HFNC failure subgroup, the median length of respiratory support was 3-fold longer (63h) and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success., Conclusions: Despite its obvious limitations, this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support, and longer PICU LOS., (Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Objectives: To estimate the cost and characterize the management of asthma attacks in primary care., Design: Prospective, observational study of 1 year's duration. Setting. 10 physician's offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain., Participants: 10 family physicians who saw 133 consecutive patients with an asthma attack., Method: Prospective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians' habitually used procedures; the study protocol did not specify any predetermined intervention., Results: The attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was 166.7 (95% CI, 146.5-192.3); 80% (132.4) (95% CI, 122.7-143.8) were direct costs and 20% (34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician., Conclusions: Mean cost of each asthma attack treated in primary care was 166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs.

Objective: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries., Patients and Methods: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000)., Results: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting beta2 agonists. The mean cost was 1555.70 Euros (95% confidence interval [CI], 1237.60 Euros-1907.00 Euros), of which 93.8% (1460.60 Euros; 95% CI, 1152.50 Euros-1779.40 Euros) was due to direct costs, and 6.2% (95.10 Euros; 95% CI, 35.50 Euros-177.00 Euros) to indirect costs. Cost rose with increasing severity of the exacerbation--292.60 Euros for a mild exacerbation, 1230.50 Euros for a moderate exacerbation, and 3543.10 Euros for a severe exacerbation., Conclusions: The mean cost was 1555.70 Euros. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting beta2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.