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Not all nebulizers are created equal: Considerations in choosing a nebulizer for aerosol delivery during mechanical ventilation. 并非所有雾化器都是平等的:在机械通气期间选择雾化器进行气溶胶输送的考虑因素。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17476348.2023.2183194
Ronan MacLoughlin, Ignacio Martin-Loeches

Introduction: Aerosol therapy is commonly prescribed in the mechanically ventilated patient. Jet nebulizers (JN) and vibrating mesh nebulizers (VMN) are the most common nebulizer types, however, despite VMN's well established superior performance, JN use remains the most commonly used of the two. In this review, we describe the key differentiators between nebulizer types and how considered selection of nebulizer type may enable successful therapy and the optimization of drug/device combination products.

Areas covered: Following a review of the published literature up to February 2023, the current state of the art in relation to JN and VMN is discussed under the headings of in vitro performance of nebulizers during mechanical ventilation, respective compatibility with formulations for inhalation, clinical trials making use of VMN during mechanical ventilation, distribution of nebulized aerosol throughout the lung, measuring the respective performance of nebulizers in the patient and non-drug delivery considerations in nebulizer choice.

Expert opinion: Whether for standard care, or the development of drug/device combination products, the choice of nebulizer type should not be made without consideration of the unique needs of the combination of each of drug, disease and patient types, as well as target site for deposition, and healthcare professional and patient safety.

简介:气雾剂治疗通常用于机械通气患者。喷射雾化器(JN)和振动网雾化器(VMN)是最常见的雾化器类型,然而,尽管VMN的良好建立优越的性能,JN的使用仍然是最常用的两个。在这篇综述中,我们描述了雾化器类型之间的关键区别,以及如何考虑雾化器类型的选择可能使成功的治疗和药物/设备组合产品的优化。覆盖区域:在回顾了截至2023年2月的已发表文献后,在以下标题下讨论了有关JN和VMN的最新技术:机械通气期间雾化器的体外性能、与吸入配方的各自兼容性、在机械通气期间使用VMN的临床试验、雾化气溶胶在整个肺部的分布、测量雾化器在患者中的各自性能和雾化器选择中的非药物输送考虑。专家意见:无论是标准护理,还是药物/器械组合产品的开发,雾化器类型的选择都不应不考虑每种药物、疾病和患者类型组合的独特需求,以及沉积靶点,以及医疗保健专业人员和患者的安全。
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引用次数: 3
An expert overview of pulmonary fibrosis in sarcoidosis. 结节病肺纤维化的专家综述。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17476348.2023.2183193
Rohit Gupta, Jin Sun Kim, Robert P Baughman

Introduction: Advanced pulmonary sarcoidosis refers to phenotypes of pulmonary sarcoidosis that often lead to significant loss of lung function, respiratory failure, or death. Around 20% of patients with sarcoidosis may progress to this state which is mainly driven by advanced pulmonary fibrosis. Advanced fibrosis often presents with associated complications of sarcoidosis including infections, bronchiectasis, and pulmonary hypertension.

Areas covered: This article will focus on the pathogenesis, natural history of disease, diagnosis, and potential treatment options of pulmonary fibrosis in sarcoidosis. In the expert opinion section, we will discuss the prognosis and management of patients with significant disease.

Expert opinion: While some patients with pulmonary sarcoidosis remain stable or improve with anti-inflammatory therapies, others develop pulmonary fibrosis and further complications. Although advanced pulmonary fibrosis is the leading cause of death in sarcoidosis, there are no evidence-based guidelines for the management of fibrotic sarcoidosis. Current recommendations are based on expert consensus and often include multidisciplinary discussions with experts in sarcoidosis, pulmonary hypertension, and lung transplantation to facilitate care for such complex patients. Current works evaluating treatments include the use of antifibrotic therapies for treatment in advanced pulmonary sarcoidosis.

晚期肺结节病是指肺结节病的表型,通常导致肺功能明显丧失,呼吸衰竭或死亡。大约20%的结节病患者可能发展到这种状态,主要是由晚期肺纤维化驱动的。晚期纤维化常伴有结节病的并发症,包括感染、支气管扩张和肺动脉高压。涉及领域:本文将重点介绍结节病肺纤维化的发病机制、疾病的自然史、诊断和潜在的治疗选择。在专家意见部分,我们将讨论重大疾病患者的预后和处理。专家意见:虽然一些肺结节病患者通过抗炎治疗保持稳定或改善,但其他患者会发展为肺纤维化和进一步的并发症。虽然晚期肺纤维化是结节病死亡的主要原因,但尚无基于证据的纤维化结节病治疗指南。目前的建议是基于专家共识,通常包括与结节病、肺动脉高压和肺移植专家的多学科讨论,以促进对此类复杂患者的护理。目前评估治疗的工作包括使用抗纤维化疗法治疗晚期肺结节病。
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引用次数: 1
Respiratory management in the premature neonate. 早产儿的呼吸管理。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17476348.2023.2183843
Vikramaditya Dumpa, Indirapriya Avulakunta, Vineet Bhandari

Introduction: Advances in neonatal care have made possible the increased survival of extremely preterm infants. Even though there is widespread recognition of the harmful effects of mechanical ventilation on the developing lung, its use has become imperative in the management of micro-/nano-preemies. There is an increased emphasis on the use of less-invasive approaches such as minimally invasive surfactant therapy and non-invasive ventilation that have been proven to result in improved outcomes.

Areas covered: Here, we review the evidence-based practices surrounding the respiratory management of extremely preterm infants including delivery room interventions, invasive and non-invasive ventilation approaches, and specific ventilator strategies in respiratory distress syndrome and bronchopulmonary dysplasia. Adjuvant relevant respiratory pharmacotherapies used in preterm neonates are also discussed.

Expert opinion: Early use of non-invasive ventilation and use of less invasive surfactant administration are key strategies in the management of respiratory distress syndrome in preterm infants. Ventilator management in bronchopulmonary dysplasia must be tailored according to the individual phenotype. There is strong evidence to start caffeine early to improve respiratory outcomes, but evidence is lacking on the use of other pharmacological agents in preterm neonates, and an individualized approach has to be considered for their use.

新生儿护理的进步使极早产儿的存活率增加成为可能。尽管人们普遍认识到机械通气对发育中的肺的有害影响,但在微/纳米早产儿的管理中,机械通气的使用已变得势在必行。微创表面活性剂治疗和无创通气等微创方法已被证明可以改善预后,因此越来越重视使用这些方法。涉及领域:在这里,我们回顾了围绕极早产儿呼吸管理的循证实践,包括产房干预,有创和无创通气方法,以及呼吸窘迫综合征和支气管肺发育不良的特定呼吸机策略。辅助相关呼吸药物治疗用于早产儿也进行了讨论。专家意见:早期使用无创通气和使用无创表面活性剂是处理早产儿呼吸窘迫综合征的关键策略。支气管肺发育不良的呼吸机管理必须根据个体表型量身定制。有强有力的证据表明,早期服用咖啡因可以改善呼吸系统的预后,但在早产儿中使用其他药物方面缺乏证据,因此必须考虑个体化的方法。
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引用次数: 1
Managing cystic fibrosis in children aged 6-11yrs: a critical review of elexacaftor/tezacaftor/ivacaftor combination therapy. 6-11岁儿童囊性纤维化的治疗:elexaftor /tezacaftor/ivacaftor联合治疗的重要回顾
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17476348.2023.2179989
Kamyron D Jordan, Edith T Zemanick, Jennifer L Taylor-Cousar, Jordana E Hoppe

Introduction: Cystic fibrosis is a life-limiting, autosomal recessive genetic disorder resulting in multi-organ disease due to CF transmembrane conductance regulator (CFTR) protein dysfunction. CF treatment previously focused on mitigation of disease signs and symptoms. The recent introduction of highly effective CFTR modulators, for which ~90% of people with CF are CFTR variant-eligible, has resulted in substantial health improvements.

Areas covered: In this review, we will describe the clinical trials leading to approval of the highly effective CFTR modulator, elexacaftor-tezacaftor-ivacaftor (ETI), with a focus on the safety and efficacy of this treatment in children aged 6-11 years.

Expert opinion: The use of ETI in variant-eligible children aged 6-11 is associated with marked clinical improvements with a favorable safety profile. We anticipate that introduction of ETI in early childhood may result in the prevention of pulmonary, gastrointestinal, and endocrine complications from CF, consequently leading to previously unimaginable gains in the quality and quantity of life. However, there is an urgent need to develop effective treatments for the remaining 10% of people with CF who are not eligible or unable to tolerate ETI treatment, and to increase access of ETI to more pwCF across the world.

简介:囊性纤维化是一种限制生命的常染色体隐性遗传病,由于CF跨膜传导调节因子(CFTR)蛋白功能障碍导致多器官疾病。CF治疗以前侧重于减轻疾病体征和症状。最近引入了高效CFTR调节剂,约90%的CF患者符合CFTR变异体条件,从而显著改善了健康状况。涵盖领域:在本综述中,我们将描述导致高效CFTR调节剂elexacaftor- tezacator -ivacaftor (ETI)获批的临床试验,重点关注该治疗在6-11岁儿童中的安全性和有效性。专家意见:在6-11岁的儿童中使用ETI与显著的临床改善和良好的安全性相关。我们预计,在儿童早期引入ETI可能会预防CF引起的肺部、胃肠道和内分泌并发症,从而在生活质量和数量方面带来以前难以想象的收益。然而,对于剩余10%不符合条件或无法耐受ETI治疗的CF患者,迫切需要开发有效的治疗方法,并在全球范围内增加ETI对更多pwCF的可及性。
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引用次数: 5
The prevention and management strategies for neonatal chronic lung disease. 新生儿慢性肺病的预防和管理策略。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17476348.2023.2183842
Christopher Harris, Anne Greenough

Introduction: Survival from even very premature birth is improving, but long-term respiratory morbidity following neonatal chronic lung disease (bronchopulmonary dysplasia (BPD)) has not reduced. Affected infants may require supplementary oxygen at home, because they have more hospital admissions particularly due to viral infections and frequent, troublesome respiratory symptoms requiring treatment. Furthermore, adolescents and adults who had BPD have poorer lung function and exercise capacity.

Areas covered: Antenatal and postnatal preventative strategies and management of infants with BPD. A literature review was undertaken using PubMed and Web of Science.

Expert opinion: There are effective preventative strategies which include caffeine, postnatal corticosteroids, vitamin A, and volume guarantee ventilation. Side-effects, however, have appropriately caused clinicians to reduce use of systemically administered corticosteroids to infants only at risk of severe BPD. Promising preventative strategies which need further research are surfactant with budesonide, less invasive surfactant administration (LISA), neurally adjusted ventilatory assist (NAVA) and stem cells. The management of infants with established BPD is under-researched and should include identifying the optimum form of respiratory support on the neonatal unit and at home and which infants will most benefit in the long term from pulmonary vasodilators, diuretics, and bronchodilators.

导读:即使是非常早产的生存率也在提高,但新生儿慢性肺病(支气管肺发育不良(BPD))后的长期呼吸系统发病率并没有降低。受影响的婴儿可能需要在家中补充氧气,因为他们住院的次数更多,特别是由于病毒感染和频繁出现的、麻烦的呼吸道症状需要治疗。此外,患有BPD的青少年和成人肺功能和运动能力较差。涵盖的领域:BPD婴儿的产前和产后预防策略和管理。使用PubMed和Web of Science进行文献综述。专家意见:有有效的预防策略包括咖啡因,产后皮质类固醇,维生素A和容量保证通气。然而,副作用已适当地导致临床医生减少仅对有严重BPD风险的婴儿使用全身给药皮质类固醇。需要进一步研究的有表面活性剂联合布地奈德、无创表面活性剂给药(LISA)、神经调节通气辅助(NAVA)和干细胞等预防策略。对已确诊BPD的婴儿的管理研究尚不充分,应包括在新生儿病房和家中确定呼吸支持的最佳形式,以及哪些婴儿将从肺血管扩张剂、利尿剂和支气管扩张剂中长期受益。
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引用次数: 0
Mepolizumab for the treatment of chronic rhinosinusitis with nasal polyps in adults. Mepolizumab用于治疗成人慢性鼻窦炎伴鼻息肉。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17476348.2023.2181794
Josh Neposlan, Leigh J Sowerby, Ameen Biadsee

Introduction: The treatment paradigm for chronic rhinosinusitis with nasal polyps (CRSwNP) is complex, consisting of a combination of conservative, medical and surgical management. High rates of recurrence despite current standard of care has led to the search for treatments that can improve outcomes and limit the treatment burden for patients living with this chronic condition.

Areas covered: Eosinophils are granulocytic white blood cells that proliferate as part of the innate immune response. IL5 is an inflammatory cytokine implicated in the development of eosinophil-associated diseases that has emerged as a target for biologic therapy. Mepolizumab (NUCALA) is a humanized antiIL5 monoclonal antibody that represents a novel therapeutic approach to CRSwNP. The results of multiple clinical trials are encouraging but its real-world implementation requires a thorough cost-benefit analysis across a range of clinical situations.

Expert opinion: : Mepolizumab is an emerging biologic therapy that shows promising potential for the treatment of CRSwNP. It appears to provide both objective and subjective improvement as an addon therapy to standard of care treatment. Its specific role in treatment algorithms remains a topic of discussion. Future research surrounding its efficacy and cost effectiveness as compared to alternative options is needed.

慢性鼻窦炎合并鼻息肉(CRSwNP)的治疗模式是复杂的,包括保守、内科和外科治疗的结合。尽管目前的治疗标准很高,但复发率仍然很高,这促使人们寻找能够改善治疗结果并限制这种慢性疾病患者治疗负担的治疗方法。涉及领域:嗜酸性粒细胞是粒细胞性白细胞,作为先天免疫反应的一部分增殖。IL5是一种炎性细胞因子,与嗜酸性粒细胞相关疾病的发展有关,已成为生物治疗的靶点。Mepolizumab (NUCALA)是一种人源化抗il5单克隆抗体,代表了一种新的治疗CRSwNP的方法。多项临床试验的结果令人鼓舞,但其在现实世界的实施需要在一系列临床情况下进行彻底的成本效益分析。专家意见:Mepolizumab是一种新兴的生物疗法,在治疗CRSwNP方面显示出良好的潜力。它似乎提供客观和主观的改善,作为标准护理治疗的附加疗法。它在治疗算法中的具体作用仍然是一个讨论的话题。与其他选择相比,需要进一步研究其功效和成本效益。
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引用次数: 0
Effect of kidney transplantation on indices of cardiorespiratory fitness assessed with cardiopulmonary exercise testing: a systematic review and meta-analysis. 肾移植对心肺运动试验评估的心肺功能指标的影响:系统回顾和荟萃分析。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17476348.2023.2182772
Eva Pella, Maria-Eleni Alexandrou, Afroditi Boutou, Marieta Theodorakopoulou, Konstantina Dipla, Andreas Zafeiridis, Pantelis Sarafidis

Background: Patients with kidney failure often present with reduced cardiovascular reserve. Kidney transplantation (KT) is the optimal treatment for patients with end-stage kidney disease as it is associated with longer survival and improved quality of life compared to dialysis.

Methods: This is a systematic review and meta-analysis of studies using cardiopulmonary-exercise-testing to examine the cardiorespiratory fitness of patients with kidney failure before and after KT. The primary outcome was difference in pre- and post-transplantation values of peak oxygen uptake (VO2peak). Literature search involved three databases (PubMed-Web of Science-Scopus), manual search, and grey literature.

Results: From 379 records initially retrieved, six studies were included in final meta-analysis. A marginal, but not significant, improvement was observed in VO2peak after KT compared to pre-transplantation values (SMD: 0.32, 95%CI -0.02; 0.67). Oxygen consumption at anaerobic threshold was significantly improved after KT (WMD: 2.30 ml/kg/min, 95%CI 0.50; 4.09). Consistent results were shown between preemptive and after-dialysis-initiation transplantation and a trend for improvement in VO2peak was observed at least 3 months post-transplantation, but not earlier.

Conclusion: Several major indices of cardiorespiratory fitness tend to improve after KT. This finding may represent another modifiable factor contributing to better survival rates of kidney transplant recipients compared to patients undergoing dialysis.

背景:肾衰竭患者常表现为心血管储备减少。肾移植(KT)是终末期肾病患者的最佳治疗方法,因为与透析相比,它与更长的生存期和更高的生活质量有关。方法:这是一项系统综述和荟萃分析,研究使用心肺运动测试来检查肾衰患者在KT前后的心肺功能。主要结果是移植前后的峰值摄氧量(vo2峰值)值的差异。文献检索涉及三个数据库(PubMed-Web of Science-Scopus)、人工检索和灰色文献。结果:从最初检索的379份记录中,有6项研究被纳入最终的荟萃分析。与移植前值相比,KT后vo2峰值有轻微但不显著的改善(SMD: 0.32, 95%CI -0.02;0.67)。KT后厌氧阈耗氧量显著提高(WMD: 2.30 ml/kg/min, 95%CI 0.50;4.09)。预先移植和透析后开始移植的结果一致,并且在移植后至少3个月观察到vo2峰值的改善趋势,但不早于此。结论:KT术后心肺功能指标有改善的趋势。这一发现可能代表了另一个可改变的因素,有助于肾移植受者比接受透析的患者生存率更高。
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引用次数: 0
Letter to the editor: "Clinical controversies in the management of acute pulmonary embolism". 致编辑的信:“急性肺栓塞治疗中的临床争议”。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-05-18 DOI: 10.1080/17476348.2023.2214733
Scott D Casey, Samuel G Rouleau, David R Vinson, Nareg H Roubinian
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引用次数: 0
Response to letter to the editor: "Clinical controversies in the management of acute pulmonary embolism: evaluation of four important but controversial aspects of acute pulmonary embolism management that are still subject of debate and research". 回复编辑的信:“急性肺栓塞治疗中的临床争议:对急性肺栓塞管理的四个重要但有争议的方面的评估,这些方面仍然是争论和研究的主题”。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-05-19 DOI: 10.1080/17476348.2023.2215015
Dieuwke Luijten, Frederikus A Klok, Thijs E van Mens, Menno V Huisman
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引用次数: 0
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients. 胸膜疾病的最佳诊断策略及高危患者的识别。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1080/17476348.2023.2174527
D N Addala, P Denniston, A Sundaralingam, N M Rahman

Introduction: Pleural diseases encompass a broad range of conditions with diverse and heterogenous etiologies. Diagnostics in pleural diseases thus represents a challenging field with a wide array of available testing to distinguish between the numerous causes of pleural disease. Nonetheless, deploying best practice diagnostics in this area is essential in reducing both duration o the investigation pathway and symptom burden.

Areas covered: This article critically appraises the optimal diagnostic strategies and pathway in patients with pleural disease, reviewing the latest evidence and key practice points in achieving a treatable diagnosis in patients with pleural disease. We also cover future and novel directions that are likely to influence pleural diagnostics in the near future. PubMed was searched for articles related to pleural diagnostics (search terms below), with the date ranges including June 2012 to June 2022.

Expert opinion: No single test will ever be sufficient to provide a diagnosis in pleural conditions. The key to reducing procedure burden and duration to diagnosis lies in personalizing the investigation pathway to patients and deploying tests with the highest diagnostic yield early (such as pleural biopsy in infection and malignancy). Novel biomarkers may also allow earlier diagnostic precision in the near future.

简介:胸膜疾病包括广泛的条件与多样和异质的病因。因此,胸膜疾病的诊断是一个具有挑战性的领域,有广泛的可用测试来区分胸膜疾病的众多原因。尽管如此,在这一领域部署最佳实践诊断对于缩短调查途径的持续时间和减轻症状负担至关重要。涵盖领域:本文批判性地评价胸膜疾病患者的最佳诊断策略和途径,回顾最新的证据和关键实践要点,以实现胸膜疾病患者可治疗的诊断。我们还涵盖了在不久的将来可能影响胸膜诊断的未来和新方向。在PubMed中搜索与胸膜诊断相关的文章(搜索词如下),日期范围包括2012年6月至2022年6月。专家意见:对于胸膜疾病,没有任何单一的检查能够提供足够的诊断。减少手术负担和缩短诊断时间的关键在于对患者进行个性化的检查途径,并在早期部署诊断率最高的检查(如感染和恶性肿瘤的胸膜活检)。在不久的将来,新的生物标记物也可能使早期诊断更加精确。
{"title":"Optimal diagnostic strategies for pleural diseases and identifying high-risk patients.","authors":"D N Addala,&nbsp;P Denniston,&nbsp;A Sundaralingam,&nbsp;N M Rahman","doi":"10.1080/17476348.2023.2174527","DOIUrl":"https://doi.org/10.1080/17476348.2023.2174527","url":null,"abstract":"<p><strong>Introduction: </strong>Pleural diseases encompass a broad range of conditions with diverse and heterogenous etiologies. Diagnostics in pleural diseases thus represents a challenging field with a wide array of available testing to distinguish between the numerous causes of pleural disease. Nonetheless, deploying best practice diagnostics in this area is essential in reducing both duration o the investigation pathway and symptom burden.</p><p><strong>Areas covered: </strong>This article critically appraises the optimal diagnostic strategies and pathway in patients with pleural disease, reviewing the latest evidence and key practice points in achieving a treatable diagnosis in patients with pleural disease. We also cover future and novel directions that are likely to influence pleural diagnostics in the near future. PubMed was searched for articles related to pleural diagnostics (search terms below), with the date ranges including June 2012 to June 2022.</p><p><strong>Expert opinion: </strong>No single test will ever be sufficient to provide a diagnosis in pleural conditions. The key to reducing procedure burden and duration to diagnosis lies in personalizing the investigation pathway to patients and deploying tests with the highest diagnostic yield early (such as pleural biopsy in infection and malignancy). Novel biomarkers may also allow earlier diagnostic precision in the near future.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9226614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Expert Review of Respiratory Medicine
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