Background:Long COVID is a heterogeneous clinical syndrome characterised by a variety of reported symptoms and signs. Its clinical management is expected to differ significantly worldwide. Methods:A survey-based study investigating long COVID-related standard operating procedures (SOPs) has been conducted by the European Respiratory Society (ERS) END-COVID clinical research collaboration with the support of other international societies (ALAT, APSR, CHEST, ESCMID and PATS). A global analysis of the results is provided here, alongside sub-population analysis based on continents, national income levels, type of involved healthcare professional and inclusion or exclusion of paediatric patients. Findings:1015 healthcare professionals from 110 different countries worldwide participated in this study, the majority of them being respiratory physicians (60.6%). A dedicated long COVID programme was present in 55.4% of the investigated institutions, with hospital admission during the acute infection being the main inclusion criteria to access them. Consistent differences in long COVID-related procedures were identified among centres, mainly regarding the multidisciplinary approach, the availability of telemedicine and psychological support, the type of requested exams and the total amount of visits in the centre. Interpretation:Long COVID management shows important differences related to geographical areas and national income levels. SOPs were significantly different when centres were managed by a pulmonologist or when paediatric patients were included.

Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems. A graphical plain language summary is available with this article.

Hantavirus cardiopulmonary syndrome (HCPS) is a zoonosis caused by the Andes virus and does not have a specific therapy. Mortality due to Hantavirus infection is high. This increases to more than 60% in critical patients. We evaluated clinical and laboratory markers as predictors in the evolution to severe Hantavirus infection, defined as use of mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) support. Consecutive patients with Hantavirus infection confirmed by serological test or RT-PCR were admitted in the ICU of INT and studied prospectively. Demographic, clinical, and laboratory data, Apache II and SOFA score, transfer time to the ICU, start time of ECMO and MV were collected. Independent risk factors for severe Hantavirus infection were identified by means of logistic regression analysis. The study was approved by the local ethic's committee. From January 2015 to January 2023, 52 patients were included in the study. The mean age was 36 (SD 14) years; 72% were men. Transfer time to ICU was 20 (SD 26.9) Hours. 16 patients received O2 through the nose, 15 only MV, and 21 MV and ECMO. The global survival was 90%. Multivariate analysis showed that SOFA score on admission is an independent risk factor to the predictor for progression to severe Hantavirus infection (OR, 1.7; 95%CI, 1.0-3.0). The AUC was 0,8920 and the best cutoff point of SOFA score is 6, with 68% sensitivity and 100% specificity. The calculation of SOFA score on admission can help predict progression to severe Hantavirus and early use of ECMO and/or MV.

Introduction: COVID-19 is a potentially life-threatening disease, particularly in older adults with comorbidities, associated to a high incidence of hospitalization and in-patients mortality. There are few studies that describe mortality and risk factors after one year follow up. Methods: We analyzed clinical data, mortality, and calculated age-adjusted Charlson Comorbidity Index (ACCI) of 15 years and older COVID-19 patients hospitalized with acute respiratory failure, and for a period of one year after admission to the Regional Hospital of Arica, the only center for a region of 200.000 habitants. Then a multivariable analysis was conducted. Results: 1 064 patients were admitted for SARS-COV2 infection and acute respiratory failure. 664 were male (62.4%), median (IQR) age was 56 (43-68) years, and median (IQR) ACCI was 2 (0-3). The overall hospital mortality was 18%, and 3.9% among survivors one year post admission. The multivariable analysis identified 5 risk factors for hospital mortality: ACCI (OR 10.7; 95%CI 6.6-17.3), anemia (OR 2.0; 95%CI 1.3-3.3), thrombocytopenia (OR 2.8; 95%CI 1.7-4.7), high-flow nasal cannula (OR 5; 95%CI 2.5-9.9) and mechanical ventilation (OR 3.1; 95%CI 1.9-5.0). The post discharge mortality risk factors were ACCI (OR 17.2; 95%CI 4.8-61.1), anemia (OR 3.8; 95%CI 1.5-9.8), thrombocytopenia (OR 5.1; 95%CI 2.1-16.5) and a normal LDH (OR 4.4; 95%CI 1.5-12.9). Conclusions: Age and comorbidities were the most important risk factors to predict in-hospital and after discharge mortality. Unlike mortality during hospitalization, patients with ventilatory support didn't have worse outcomes than the rest of the patients after one year follow up.

Introduction: metered dose inhalers (MDI) are fundamental in treating obstructive diseases. However, there is evidence of its incorrect use and therefore limited benefits. This work aims to evaluate the use of MDIs and to know the impact of education on the correct inhalation technique. Method: prospective, before-after study, carried out in hospitalized and outpatients. Demographic data and data on the use of the MDI are recorded. Subsequently, the patient was asked to take 2 inhalations with his MDI and valved-holding chamber, a score was given according to the ESTI score and he was educated orally, visually, and with an explanatory brochure. The patients were reassessed within 1 month of the first evaluation. Results: 119 patients were included, 53.8% male, with a mean age of 60.6 (±16) years. 60.5% always used an aero chamber and 19.3% almost always. 65% had the perception that their inhalation technique was good or very good. 32% did not know how to identify their rescue inhaler. The score on the baseline ESTI scale was 6.8 (± 2.3) points, which improved in the reassessment, 8.7 (± 1.5) points; p<0.0001. The inhalation technique rated as very good or good improved from 24.4% to 63%; p<0.0001. Conclusion: our results show that the inhalation technique with MDI is deficient and active education demonstrates a significant impact on the correct use of these devices.

New World hantaviruses are important human pathogens that can cause a severe zoonotic disease called hantavirus cardiopulmonary syndrome (HCPS). HCPS patients can progress quickly to a severe condition with respiratory failure and cardiogenic shock that can be fatal in 30% of the cases. The role of the host's immune responses in this progression towards HCPS remains elusive. In this study, 12 patients hospitalized with severe HCPS were analyzed using a transcriptome approach combined with clinical laboratory data to gain a better insight into factors associated with a severe clinical course. Patients were further classified in two levels of severity, a first group that required mechanical ventilation and vasoactive drugs (VM+VD) and a second group that also needed ECMO or died (ECMO/Fatal). Their transcriptional profile was compared during acute (early and late) and convalescent phases. Our results showed that overexpression of the interferon response is correlated with a worse (ECMO/Fatal) outcome and an increased viral load and proinflammatory cytokines in the early-acute-phase. This report provides insights into the differences in innate immune activation between severe patients that associates with different clinical outcomes, using a non-biased approximation.

BACKGROUND: Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. RESEARCH QUESTION: There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. STUDY DESIGN AND METHODS: This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. RESULTS: The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. INTERPRETATION: This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.

Bronchiectasis is a very heterogeneous disease but some homogeneous groups with similar clinical characteristics and prognosis have been identified. Exacerbations have been shown to have a negative impact on the natural history of bronchiectasis. The objective of this study was to identify the definition and characteristics of the "frequent exacerbator patient" with the best prognostic value and its relationship with the severity of bronchiectasis. A historical cohort of 651 patients diagnosed with bronchiectasis was included. They had all received 5 years of follow-up since their radiological diagnosis. Exacerbation was defined as a worsening of the symptoms derived from bronchiectasis that required antibiotic treatment. The main outcome was all-cause mortality at the end of follow-up. The mean age was 48.2 (16) years (32.9% males). 39.8% had chronic infection by Pseudomonas aeruginosa. Mean BSI, FACED, and E-FACED were 7 (4.12), 2.36 (1.68), and 2.89 (2.03), respectively. There were 95 deaths during follow-up. The definition of the "frequent exacerbator patient" that presented the greatest predictive power for mortality was based on at least two exacerbations/year or one hospitalization/year (23.3% of patients; AUC-ROC: 0.75 [95% CI: 0.69–0.81]). Its predictive power was independent of the patient's initial severity. The clinical characteristics of the frequent exacerbator patient according to this definition varied according to the initial severity of bronchiectasis, presence of systemic inflammation, and treatment. The combination of two exacerbations or one hospitalization per year is the definition of frequent exacerbator patient that has the best predictive value of mortality independent of the initial severity of bronchiectasis. Las bronquiectasias son una enfermedad muy heterogénea en la que se han identificado algunos grupos homogéneos con características clínicas y pronóstico similares. El objetivo de este estudio fue establecer la definición y características del "paciente exacerbador frecuente" que presenta mejor valor pronóstico y su relación con la gravedad de las bronquiectasias. Se analizó una cohorte histórica de 651 pacientes diagnosticados de bronquiectasias. Se siguió a todos ellos durante cinco años desde su diagnóstico radiológico. La exacerbación se definió como un empeoramiento de los síntomas de las bronquiectasias para el que se requiera tratamiento antibiótico. El principal resultado analizado fue la mortalidad por todas las causas al final del seguimiento. La edad media fue 48,2 (16) años (39,2% de hombres). El 38,9% tuvo infección por Pseudomonas aeruginosa. Los valores medios de BSI, FACED y E-FACED fueron 7 (4,12), 2,36 (1,68) y 2,89 (2,03), respectivamente. Hubo 96 muertes durante el seguimiento. La definición de "paciente exacerbador frecuente" que presentó el mayor valor predictivo para la mortalidad incluía la aparición de al menos dos exacerbaciones/año o un ingreso hospitalario/año (23.3% de los pacientes; AUC-ROC:0.75 [IC 95%: 0.69–0.81]). Su valor predictivo fue independiente de la gravedad inicial del paciente. Las características clínicas del "paciente exacerbador frecuente", de acuerdo con esta definición, variaron según la gravedad inicial de la bronquiectasia, la presencia de inflamación sistémica y el tratamiento. La combinación de dos exacerbaciones o un ingreso hospitalario al año constituye la mejor definición de "paciente exacerbador frecuente" con mayor valor predictivo para la mortalidad, independientemente de la gravedad inicial de las bronquiectasias.

Both FACED and E-FACED scores have shown good short-term prognostic value for predicting mortality in bronchiectasis http://ow.ly/albl30i11bv.

The FACED score is an easy-to-use multidimensional grading system that has demonstrated an excellent prognostic value for mortality in patients with bronchiectasis. A Spanish group developed the score but no multicenter international validation has yet been published.

Purpose of Review The increase in drug-resistant community-acquired pneumonia ( CAP) is an important problem all over the world. This article explores the current state of antimicrobial resistance of different bacteria that cause CAP and also assesses risk factors to identify those pathogens.Recent Findings In the last two decades, it has been documented that there is a significant increase in drug-resistant Streptococcus pneumoniae and other bacteria causing CAP. The most important risk factors are overuse of antibiotics, prior hospitalization, and lung comorbidities. The direct consequences can be severe, including prolonged stays in hospital, increased costs, and morbimortality. However, drug-resistant CAP declined after the introduction of the pneumococcal conjugate vaccine.Summary This review found an increase in resistance to the antibiotics used in CAP, and the risk factor can be used for identifying patients with drug-resistant CAP and initiate appropriate treatment. Judicious use of antibiotics and the development of effective new vaccines are needed.

Background: Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients.Objective: Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality.Methods: The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts.Results: A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78, P < 0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED.Conclusion: E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score's simplicity and prognostic capacity for death.

Objective: to perform an external validation of FACED score in a large series of patients with bronchiectasis. Methods: Multicentric study in 672 consecutive patients with bronchiectasis (HRCT diagnosis) from six cohorts from Argentina, Brazil and Chile. Data were collected using the same standardized protocol and criteria used in the original paper. Vital status was determined at 5 yr from the diagnosis. The area under ROC curve (AUC-ROC) was used to calculate the predictive power of FACED score for all cause and respiratory deaths compared with the original paper. Patients were divided into there score groups (tertiles).Results: Mean age: 48.4(16.1)yr; MRC-Dyspnea:1.53(1) and 3.4(1.5) pulmonary lobes affected. FEV1 was 54.7% and 1.2 exac/year. 39% colonized by P aeruginosa. During follow-up 100 patients (14.9%) died (67% from respiratory causes). 27.5% and 39.6% of patients had idiopathic and postinfectious bronchiectasis respectively. Mean FACED score: 2.31(1.64). AUC-ROC to predict all-cause mortality (0.81[95%CI:0.78-0.85] and to respiratory mortality (0.84[95%CI:0.80-0.88]) were not different from the original series (0.87[95%CI:0.82-0.91]) and (0.85 [95%CI:0.82-0.89]) respectively. The division into tertiles differenciated bronchiectasis into three mortality groups (0-2 points[mild]:4.9% mortality; 3-4 points[moderate]:21.1% and 5-7 points[severe]:47% mortality; p<0.001) with no significant differences compared with the original series (0.9%; 15.3% and 51.6%). Conclusion: FACED score has an adequate external validation mantaining an excellent predictive power for mortality as well as its capacity to divide bronchiectasis into three groups of increase severity.

Background: In US and European literature, Legionella pneumophila is reported as an important etiologic agent of severe community-acquired pneumonia (CAP), but in Chile this information is lacking. The aim of this study was to determine the incidence and identify predictors of severe CAP caused by L pneumophila in Santiago, Chile.Methods: A multicenter, prospective clinical study lasting 18 months was conducted; it included all adult patients with severe CAP admitted to the ICUs of four hospitals in Santiago. We excluded patients who were immunocompromised, had been hospitalized in the previous 4 weeks, or presented with another disease during their hospitalization. All data for the diagnosis of severe CAP were registered, and urinary antigens for L pneumophila serogroup 1 were determined.Results: A total of 104 patients with severe CAP were included (mean +/- SD age, 58.3 +/- 19.3 years; men, 64.4%; APACHE (Acute Physiology and Chronic Health Evaluation) II score, 16.7 +/- 6.3; Sepsis-related Organ Failure Assessment score, 6.1 +/- 3.2; Pitt Bacteremia Score, 3.4 +/- 2.5; PaO2/FIO2, 170.8 +/- 87.1). An etiologic agent was identified in 62 patients (59.6%), with the most frequent being Streptococcus pneumoniae (27 patients [26%]) and L pneumophila (nine patients [8.6%]). Logistic regression analysis showed that a plasma sodium level of <= 130 mEq/L was an independent predictor for L pneumophila severe CAP (OR, 11.3; 95% CI, 2.5-50.5; P = .002). Global mortality was 26% and 33% for L pneumophila. The Pitt bacteremia score and pneumonia score index were the best predictors of mortality.Conclusions: We found that in Santiago, L pneumophila was second to S pneumoniae as the etiologic agent of severe CAP. Severe hyponatremia at admission appears to be an indicator for L pneumophila etiology in severe CAP.