We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Legionnaire's disease is a disease caused by the bacteria Legionella pneumophila, that lives in contaminated water circuits such as water pipes, water tanks or reservoirs, cooling towers, swimming pools and jacuzzis.
It is contracted through the inhalation of contaminated water droplets, whether physically in the water or merely close by, due to the fact that it can spread from the water to the surrounding environment.
It normally causes a respiratory infection similar to pneumonia which if not diagnosed and treated early can be serious and life-threatening.
Legionnaire's disease causes the same symptoms as pneumonia (fever, chest pain, difficulty breathing), along with severe muscle pain and major impact on the feeling of general wellness.
Legionnaire's disease can affect anyone who has come into contact with the bacteria which cause it, but it is more common among the elderly or people with a compromised immune system who have either come into contact with or breathed the vapour of water contaminated with legionella.
A diagnosis is reached through detection of the bacteria or its antibodies in the blood, once suspected due to the clinical characteristics of the patient (age of onset, fever, major impact on general wellness, muscle pain) or radiographies (indirect pulmonary pneumonia indirectly affecting the lungs). Isolation of the bacteria is relatively recent, as it requires special culture processes.
In fact, legionella was not identified as the cause of respiratory infection until 1976 during a pneumonia epidemic in the American Legion Convention in Philadelphia, to which it owes its name.
Legionnaire's disease responds well to specific antibiotic treatment.
Early treatment is very important.
Chest x-ray, determination of legionella antibodies in the blood, specific cultures for the identification of legionella.
Epidemiological surveillance of detected cases (water pipes, air conditioning towers, swimming pools or jacuzzis involved) is very important for disinfection.
When a case of Legionnaire's disease is detected, public health authorities must initiate an investigation in order to find the source and eradicate it.
Legionella is not resistant to high temperatures and can usually be eliminated by intermittent increasing of the temperature of the pipes. This should always be carried out by a professional to ensure the proper elimination of the bacteria.
Asthma is a disorder of the passage of air through the respiratory tract, particularly in small-calibre bronchial tubes. It causes difficulty breathing and the patient feels like they are drowning and must increase their effort in an attempt to breathe better.
Asthma is a chronic inflammatory disorder of the airways that results in variable airflow obstruction. It often changes throughout the day (it can get worse at night) and improves with treatment and then reappears later.
The illness is basically caused by an inflammatory mechanism.
Three phenomena occur in the airways of patients with asthma:
1. Decreased bronchial diameter, which restricts air flow.
2. Inflammation, with increased thickness of the bronchial wall, which also contributes to restricting air flow.
3. Increased activity in the glands that produce mucus, with increased secretions contributing further to breathing difficulty.
Cells that circulate in the blood are involved in the local inflammation observed in asthma: T lymphocytes, mast cells and eosinophils. These cells are responsible for the body’s normal defence and their activity is increased in asthma. Medication for asthma attempts to regulate this activity.
According to the degree of restriction, the person affected will experience breathing difficulty and a sensation of lack of air. Also characteristic of asthma are wheezing, which is the sharp whistle-like sound of the air as it passes through the smaller airways, and increased bronchial secretion.
Asthma can affect all age groups and sometimes overlaps with bronchitis. On many occasions it can be allergic in origin or come as a result of exposure to an environmental or chemical agent.
Spirometry, chest x-ray, allergy tests.
Some basic questions for diagnosis:
1) Have you ever had a whistling sound in your chest?
2) Have you been coughing, especially at night?
3) Have you had a cough, whistling sound, difficulty breathing at some times of the year or in contact with animals, plants, tobacco or whilst at work or after exercise?
4) Have you had colds that last more than 10 days or are "chesty"?
5) Have you used inhaled medication?
Treatment is based on using bronchodilators, in the form of an inhaler or tablets. Anti-inflammatory drugs also have an important role.
The most common diagnostic tests for asthma are based on:
1) Spirometry: Measures air flow on inhaling and exhaling and detects any restrictions in the airway, one of the characteristics of asthma.
2) Bronchodilator test: Tests if spirometry improves with drugs to dilate the airway.
3) Bronchial challenge test, the same test in the opposite direction with drugs that cause a slight airway obstruction, detected by spirometry.
To prevent asthma, it is fundamental not to smoke and avoid exposure to allergens that precipitate it, which are detected with the allergy tests that form part of the asthma exam.
A procedure that, by introducing a flexible tube (bronchoscope) into the nose or mouth, allows the bronchial tree to be viewed, for diagnostic and/or therapeutic purposes.
To examine the bronchial tree and obtain samples of secretions or tissues for analysis with the aim of gaining an aetiological diagnosis of the causative illness. It can also be a therapeutic test, allowing suction of secretions or clots, extraction of foreign bodies, permeability of the airway in lung tumours and treatment of complications resulting from lung transplant.
With the patient normally lying down and consciously sedated, the bronchoscope is introduced into the airway, administering local anaesthesia in the passageways (larynx, trachea and bronchi). After examining all the bronchi and identifying any possible lesions, samples are taken, which may include: bronchial aspiration, bronchoalveolar lavage, bronchial brushing, transbronchial puncture, bronchial biopsy or transbronchial biopsy.
Minor undesirable affects may appear, such as snoring, cough, fever, localised pain, nausea or sickness and coughing up small amounts of blood, which are usually self-limiting and present no risk to life. Less commonly, major complications may occur, such as haemorrhage, low blood pressure, high blood pressure, pneumothorax (entry of air into the thorax outside of the lung). In very rare cases, complications such as arrhythmia or arrest of the heart, respiratory depression or arrest and acute stroke, may be severe and require medical or surgical treatment, including a small risk of death.
Rigid bronchoscopy, CT-guided needle lung biopsy, mediastinoscopy, surgical lung biopsy.
Simple spirometry is a test to study lung function, which lets us know the amount of air patients can move and how well they do it.
This test is done using a device called a spirometer. The patient must be sat upright with their legs uncrossed. Then, clamps are placed on the nose and the patient is asked to insert a nozzle into their mouth. Once ready, the patient must fill their lungs by breathing in as deeply as they can. The care worker then asks the patient to blow as hard as they can, not stopping until their lungs are empty. The blowing stops when the healthcare professional in charge tells the patient to stop.
Next, the patient is asked to breathe in quickly as hard as they can in order to record their inhalation data.
This can be repeated until three correct readings are taken. Normally the test lasts 10 minutes.
The only way of effectively curing tuberculosis and preventing others from catching it is through treatment based on combining different antibiotics for a minimum of six months. The symptoms of tuberculosis often disappear quickly, but the disease may come back if medication is not taken correctly and for the time indicated.
Currently, tuberculosis (TB) drugs are safe and effective, and the majority of people take them without any problems. In some cases side effects may appear, so it is important to follow the treatment plan under supervision and see a doctor in case of doubt.
Once treatment begins, and to make sure it has the desired result, follow the instructions below:
Urine, faeces, sweat and tears may be red/orange in colour. This change is normal and will disappear when the treatment comes to an end.
CDC - Preguntes i respostes sobre la tuberculosis
Amyotrophic lateral sclerosis (ALS) causes muscular degeneration that can affect motor autonomy, oral communication, swallowing and breathing, but the senses, intellect and eyes muscles remain intact. It can therefore affect the respiratory muscles, which is why respiratory care is essential for patients’ quality of life.
In order to improve the respiratory difficulties in patients, ventilation therapy can be used through non-invasive ventilation.
Ventilation therapy refers to breathing support using a ventilator, usually at night during sleep, to achieve:
Ventilation is carried out non-invasively, by means of a patient-adjusted mask (nasal or full face) connected by a tube to the ventilator or respirator.
When patients need this therapy, the place and time it is started, whether outpatient or hospital admission, is planned in a personalised way with the consent of the patient and the person caring for them.
Education for the patient and their main carer should begin as soon as possible, both from the point of view of managing secretions and the resulting care, as well as the emotional support they need to receive. This means that during the patient’s admission or outpatient visit, the patient and their carer will be trained in:
The patient and the carer must take care to keep the airway in good condition to allow secretions to be managed. It is important to preserve the ability to cough where possible, but if coughing is no longer effective, the patient and carer will need to start learning how to use mechanical aids (cough assist or mechanically assisted cough). In certain cases secretion suction may also be used.
To improve the quality of life of patients it is important to follow the advice below:
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