Pneumologie最新文献

Ungewöhnliche klinische Fälle wecken bei praktizierenden Ärzten immer wieder Interesse und ermöglichen es ihnen, ihre Wissensbasis zu erweitern und ihre Fähigkeiten zum klinischen Denken zu verbessern. Der Zweck dieser Studie besteht darin, einen klinischen Fall von Stimmresonanz beim Singen bei einem schwindsüchtigen Teenager aus dem Roman "Der Landarzt" von Honoré de Balzac unter Verwendung induktiver und deduktiver Methoden des klinischen Denkens zu analysieren. Stimmresonanzen beim Singen in Schwindsucht können als pathognomonisches Zeichen für eine kavernöse Tuberkulose gewertet werden, da nur mit dem Bronchus verbundene Hohlräume als Helmholtz-Resonator wirken. Trotz der Einzigartigkeit ist das Gehäuse durchaus realistisch, da es nicht im Widerspruch zu den Gesetzen der Akustik steht. Praktizierende Ärzte verfügen über die Kenntnisse der medizinischen Physik, Morphologie und Physiologie, die zum Verständnis der Pathogenese der klinischen Manifestation einer Lungenhöhle erforderlich sind. Dieser Fall zeigt deutlich die Vor- und Nachteile klinischer Denkmethoden, die in der Praxis eingesetzt werden. Dank der Kombination aus Originalität und Realismus kann der Fall von Stimmresonanz aus Balzacs Roman "Der Landarzt" seinen rechtmäßigen Platz in der persönlichen Sammlung klinischer Fälle eines jeden Lungenarztes einnehmen.

Cerebral metastases in patients with metastatic lung cancer are found in more than 30% of patients at baseline and manifest themselves in two out of three patients during disease evolution. For a long time, the cerebral manifestation of the disease was classified as prognostically unfavorable and hence such patients were regularly excluded from therapy studies. In the context of targeted molecular therapy strategies and established immuno-oncological systemic therapies, the blood-brain barrier no longer represents an insurmountable barrier. However, the treatment of brain metastases requires decision making in a multidisciplinary team within dedicated lung cancer and/or oncology centers. The differentiated treatment decision is based on the number, size and location of the brain metastases, neurology and general condition, comorbidities, potential life expectancy and the patient's wishes, but also tumor biology including molecular targets, extra-cranial tumor burden and availability of a CNS-effective therapy. Systemic therapies as well as neurosurgical and radiotherapeutic concepts are now often combined for optimized and prognosis-improving therapeutic strategies.

Introduction: Face masks increase airway resistance, data on the actual extent of this effect are scarce. The aim of this study was to assess the effect of different mask types on clinical parameters during moderate exercise in healthy non-smokers, active smokers and patients with interstitial lung disease (ILD) without the need of oxygen therapy.

Methods: In a prospective observational pilot study participants performed a six-minute walk test without mask, with a surgical mask, a well-fitted FFP2 mask and with a valved FFP3 mask. Respiratory rate, blood pressure, heart rate, blood gas analysis parameters, dyspnoea and six-minute walk distance were measured. Data were analysed in an ANOVA model.

Results: 21 healthy participants, 17 active smokers without known pulmonary disease and 15 patients with interstitial lung disease were included. Participants with ILD had a significant lower walking distance, a higher respiratory rate and a lower pO₂ when using FFP2 masks, but not with valved FFP3 masks or surgical masks compared to not wearing a mask.

Conclusion: For patients with ILD without the need of oxygen therapy wearing an FFP2 mask had a negative impact on pO₂, respiratory rate and walking distance in the six-minute walk test. This effect was not seen with valved FFP3 masks or surgical masks.

The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO₂/FiO₂ > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.

Background: Our centre followed a stepwise approach in the nonpharmacological treatment of respiratory failure in COVID-19 in accordance with German national guidelines, escalating non-invasive measures before invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyse this individualized approach to non-pharmacologic therapy in terms of patient characteristics and clinical features that may help predict more severe disease, particularly the need for intensive care.

Method: This retrospective single-centre study of COVID-19 inpatients between March 2020 and December 2021 analysed anthropometric data, non-pharmacological maximum therapy and survival status via a manual medical file review.

Results: Of 1052 COVID-19-related admissions, 835 patients were included in the analysis cohort (54% male, median 58 years); 34% (n=284) received no therapy, 40% (n=337) conventional oxygen therapy (COT), 3% (n=22) high flow nasal cannula (NHFC), 9% (n=73) continuous positive airway pressure (CPAP), 7% (n=56) non-invasive ventilation (NIV), 4% (n=34) intermittent mandatory ventilation (IMV), and 3% (n=29) extracorporeal membrane oxygenation (ECMO). Of 551 patients treated with at least COT, 12.3% required intubation. A total of 183 patients required ICU treatment, and 106 (13%) died. 25 (74%) IMV patients and 23 (79%) ECMO patients died. Arterial hypertension, diabetes and dyslipidemia was more prevalent in non-survivors. Binary logistic analysis revealed the following risk factors for increased mortality: an oxygen supplementation of ≥2 L/min at baseline (OR 6.96 [4.01-12.08]), age (OR 1.09 [1.05-1.14]), and male sex (OR 2.23 [0.79-6.31]).

Conclusion: The physician's immediate clinical decision to provide oxygen therapy, along with other recognized risk factors, plays an important role in predicting the severity of the disease course and thus aiding in the management of COVID-19.