Respiration最新文献

Introduction: Training-induced adaptations of the oxidative capacity have been shown to be blunted in alpha-1 antitrypsin deficiency (AATD)-related chronic obstructive pulmonary disease (COPD). To improve training outcomes in AATD, this study was aimed to compare the effects of two exercise training programmes with different training intensities.

Methods: Thirty patients with AATD (genotype PiZZ) and COPD III-IV were randomly assigned to either high-intensity (HIT) or moderate-intensity training (MIT), each consisting of endurance, strength, and squat training for a duration of 3 weeks. 6-Min walk distance (6MWD) was used as the primary outcome.

Results: Twenty-five subjects augmented with alpha-1 antitrypsin (HIT: n = 12, FEV1 41.3 ± 17.4%pred., MIT: n = 13, FEV1 45.9 ± 15.5%pred.) completed the study. In HIT and MIT, 6MWD (+37 ± 43 m vs. +32 ± 28 m, p = 0.741), 1-min sit-to-stand test (5.6 ± 4.9 repetitions vs. 5.6 ± 4.5 repetitions, p = 0.766), exercise-induced BORG dyspnoea (-1.4 ± 1.7 pts vs. -1.5 ± 2.4 pts, p = 0.952), and all CRQ domains have improved after training without between-group differences. When considering only subgroups of (probably) anxious or depressive patients (Hospital Anxiety and Depression Scale [HADS] ≥8 pts), only HIT induced a significant reduction of anxiety (-4.8 pts, 95% CI [2.1-7.5]) or depression symptoms (-5.0 pts, 95% CI [2.8-7.3]).

Conclusion: Although HIT and MIT were equally effective by improving exercise capacity, quality of life, and dyspnoea in homozygous AATD, HIT may show advantages over MIT, if anxiety or depression symptoms were present. The goal should be personalized training based on the patient's personal preference in order to achieve long-term adherence.

Introduction: Simulation-based training has proven effective for learning flexible bronchoscopy. However, no studies have tested the efficacy of training toward established proficiency criteria, i.e., mastery learning (ML). We wish to test the effectiveness of ML compared to directed self-regulated learning (DSRL) on novice bronchoscopists' end-of-training performance.

Methods: In a standardized simulated setting, novices without prior bronchoscopy experience were trained using an artificial intelligence (AI) guidance system that automatically recognizes the bronchial segments. They were randomized into two groups: the ML group and the DSRL group. The ML group was trained until they completed two procedures meeting the proficiency targets: 18 inspected segments, 18 structured progressions, <120-s procedure time. The DSRL group was trained until they no longer perceived any additional benefits from training. Both groups then did a finalizing test, without the AI guidance enabled.

Results: A total of 24 participants completed the study, with 12 in each group. Both groups had a high mean number of inspected segments (ML = 17.2 segments, DSRL = 17.3 segments, p = 0.85) and structured progressions (ML = 15.5 progressions, DSRL = 14.8 progressions, p = 0.58), but the ML group performed the test procedure significantly faster (ML = 107 s, DSRL = 180 s, p < 0.001). The ML did not spend significantly longer time training (ML = 114 min, DSRL = 109 min, p = 0.84).

Conclusions: ML is a very efficient training form allowing novice trainees to learn how to perform a thorough, systematic, and quick flexible bronchoscopy. ML does not require longer time spent training compared to DSRL, and we therefore recommend training of future bronchoscopists by this method.

Introduction: The change in prevalence and management of chronic obstructive pulmonary disease (COPD) led to changes in outcomes and costs. We aimed to assess current clinical outcomes, resource utilisation, and costs in COPD.

Methods: Retrospective, observational study of a cohort of consecutive COPD patients who visited the emergency department (ED) of a large tertiary hospital in 2018. The study measured baseline characteristics, 30-day and 1-year mortality, readmission, re-ED visit rates, and costs using the Clinical Outcomes, HEalthcare REsource utilisatioN, and relaTed costs (COHERENT) model, validated for heart failure. This model, featuring a colour graphic system, tracks time spent in different clinical situations (home, ED, hospital), considering vital status, healthcare resource use, and related costs.

Results: In 2018, 2,384 patients with a primary COPD diagnosis visited the ED. The average age was 76 years, with 40% women. Observed mortality rates were 7.6% in-hospital, 8.5% at 30 days, and 23.4% at 1 year. The readmission rates were 9.9% and 36.1%, respectively. The cohort's 1-year cost was approximately EUR 14.6 million (USD 15.95 million), with a median cost per patient of EUR 3,298 (USD 3,603.96). Hospitalisation incurred the highest costs, with initial hospitalisation and readmissions accounting for 44.7% and 42.6% of expenditures, respectively.

Conclusion: One-year mortality and readmission rates for patients with COPD visiting the ED remain high with a significant economic impact on the health system. This burden justifies special programs to improve their care.

Introduction: Patent foramen ovale (PFO) affects about 25% of the population. We studied outcomes in cystic fibrosis (CF).

Methods: We conducted a case-control study of patients with CF (PwCF) and age- and sex-matched controls who underwent agitated saline contrast (bubble) echocardiography, 1998-2020. We assessed PFO impacts using linear, logistic, quasi-Poisson, and Cox proportional hazards models.

Result: Fifty-nine of 64 PwCF and 88 of 93 controls underwent bubble studies to investigate unexplained hypoxemia or dyspnea. PwCF had higher mean pulmonary artery pressure (PAP: 6.9 mm Hg, 95% confidence interval [CI] = 2.35-11.4), reduced tricuspid annular plane systolic excursion (TAPSE: -3.78 mm, CI = -5.64 to -1.93) and similar right ventricular diastolic sizes. Without hypoxemia, the PFO incidence was similar between PwCF and controls; with hypoxemia, PFO was more common in CF (odds ratio = 5.00, CI = 1.32-19.0). In CF, oxygen supplementation occurred at a percent-predicted forced expiratory volume in 1 s (FEV1%), 22.5 points higher with PFO. Adjusted for FEV1%, PFO was associated with 0.59 more prior-year pulmonary exacerbations (CI = 0.20-0.98) and shorter time to next exacerbation (hazard ratio = 1.86, CI = 1.06-3.26). Associations between PFO and hypoxemia or exacerbations were insensitive to PAP, TAPSE, and CF transmembrane regulator protein modulator treatments. PFO was not associated with CF time to death or lung transplantation (median 1.87 years) adjusted for age, sex, FEV1%, and prior-year exacerbation counts.

Conclusion: PFO in CF is associated with hypoxemia at higher FEV1% and more pulmonary exacerbations but not survival.

Introduction: Interventional pneumology plays a crucial role in the diagnosis of peripheral pulmonary lesions (PPLs), offering a minimally invasive approach with a low risk of complications. Iriscope® is a novel device that provides a direct and real-time image of PPLs. The objective of this study was to demonstrate the feasibility and impact of Iriscope® in diagnosing PPLs by analyzing its ability to directly visualize lesions and support accurate sampling during radial probe endobronchial ultrasound (rEBUS) and electromagnetic navigation bronchoscopy (ENB) combined with rEBUS.

Methods: A single-center prospective study was conducted from December 2022 to October 2023 on patients with suspicious PPLs. The diagnostic approach involved either rEBUS alone or in combination with ENB. In all cases, an additional novel technique called Iriscope® (Lys Medical, Charleroi, Belgium) was also applied. Iriscope® findings of each lesion were evaluated individually by three expert interventional pulmonologists.

Results: Seventy PPLs suspected of malignancy were included in the study. The PPLs underwent examination by ENB combined with rEBUS (55) or by rEBUS alone (15). Diagnosis was obtained in 68.6% (48/70) of cases. Iriscope® provided a direct, real-time view of 57.1% (40/70) of PPLs with a positive predictive value of 92.5% (37/40). This technique was able to visualize 72% (39/54) of malignant lesions, while only 6.1% (1/16) of benign lesions showed pathologic changes. The most common findings observed with Iriscope® were mucosal thickening and infiltration (92.5%), increased capillary vascularization (82%), pale or grayish mucosa (72.5%), obstruction with accumulation of secretions (50%), and cobblestone mucosa (15%).

Conclusion: Iriscope® is a promising technique in the diagnostic process of PPLs, providing real-time pathologic imaging that facilitates accurate sampling. Further studies are needed to evaluate success rate of Iriscope-mediated repositioning and to establish predictive patterns for malignant or even benign diseases.

Introduction: Impulse oscillometry (IOS) is an effortless test compared to spirometry. Numerous studies explored the role of IOS in spirometry-based chronic obstructive pulmonary disease (COPD), but most of them had limited sample sizes with poor statistical power. This systematic review and meta-analysis aimed to pool the individual data and quantitatively analyze the clinical value of IOS in COPD.

Methods: PubMed, Web of Science, Ovid, Cochrane Library, China National Knowledge Internet, and Wanfang were searched for studies with comparisons of IOS indicators between COPD patients and healthy controls, including respiratory resistance at 5 Hz (R5) and 20 Hz (R20), difference between R5 and R20 (R5-R20), respiratory reactance at 5 Hz (X5), resonant frequency (Fres), and area of reactance (Ax). Meta-analyses were conducted to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs).

Results: 39 eligible studies were enrolled, involving 6,144 COPD patients and 4,611 healthy controls. Relative to healthy controls, COPD patients had significantly higher R5 (WMD: 0.17, 95% CI: 0.14, 0.20), R5-R20 (WMD: 0.13, 95% CI: 0.11, 0.15), Fres (WMD: 9.04, 95% CI: 7.66, 10.42), Ax (WMD: 1.24, 95% CI: 0.86, 1.61), and lower X5 (WMD: -0.15, 95% CI: -0.18, -0.11), and such differences became even greater as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage escalated. Pooled correlation coefficients presented that R5, R5-R20, Fres, and X5 were significantly related to post-bronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity ratio (meta r = -0.37, -0.45, -0.53, and 0.42, respectively) and FEV1 as a percentage of predicted value (meta r = -0.43, -0.54, -0.59, and 0.56, respectively).

Conclusion: IOS may be a supplement to spirometry in diagnosing and assessing COPD, especially when spirometry is inappropriate. More well-designed, large sample-sized, prospective studies are warranted to establish an IOS-based criterion for COPD management.

Introduction: The objective of this study was to compare the diagnostic performance of ultrasonography (US) and chest radiography for detecting pneumothorax in patients with trauma using a meta-analytic approach.

Methods: PubMed, Embase, and the Cochrane Library were systematically searched to identify eligible studies until March 2023. The diagnostic performance of US and chest radiography was assessed using sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic score, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC).

Results: Overall, 21 studies involving 4,087 patients with trauma were included. The overall sensitivity, specificity, PLR, NLR, diagnostic score, DOR, and AUC of US for detecting pneumothorax were 0.83, 0.99, 73.72, 0.17, 6.06, 427.80, and 0.99, respectively. The corresponding values of chest radiography for detecting pneumothorax were 0.37, 1.00, 175.59, 0.63, 5.63, 279.97, and 0.86. US was associated with a higher sensitivity (ratio: 2.24; 95% confidence interval [CI]: 1.70-2.95; p < 0.001) or AUC (ratio: 1.15; 95% CI: 1.11-1.19; p < 0.001) and lower NLR (ratio: 0.27; 95% CI: 0.17-0.43; p < 0.001) compared with chest radiography.

Conclusion: Lung US was associated with better diagnostic performance than chest radiography for detecting pneumothorax in patients with trauma.

Introduction: Cone beam computed tomography-guided navigation bronchoscopy (CBCT-NB) with augmented fluoroscopy (AF) guidance represents a minimally invasive endobronchial technique for diagnosing small, peripheral pulmonary lesions. This approach is characterized by its high diagnostic accuracy and low complication risk. Current pilot trials are exploring the application of localized therapies using this innovative approach. This report aims to provide a detailed procedural guide for performing CBCT-NB with AF guidance as the only tool for navigation and image guided biopsy.

Methods: We outline the procedural steps involved in the CBCT-NB procedure for diagnosing peripheral pulmonary lesions, supported by specific intra-procedural clinical video footage. The steps include (1) preprocedural considerations, (2) a detailed procedural workflow encompassing navigation to the target lesion, (3) position confirmation and tissue acquisition, and (4) postprocedural follow-up.

Conclusion: CBCT-NB with AF guidance is a safe and precise stand-alone navigation modality that offers high-resolution real-time 3D imaging, enhancing the diagnosis and potential treatment of peripheral pulmonary nodules.

Introduction: Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to intensive care unit (ICU) are exposed to poor clinical outcomes, and no specific prognostic models are available among this population. We aimed to develop and validate a risk score for prognosis prediction for these patients.

Methods: This was a multicenter observation study. AECOPD patients admitted to ICU were included for model derivation from a prospective, multicenter cohort study. Logistic regression analysis was applied to identify independent predictors for in-hospital death and establish the prognostic risk score. The risk score was further validated and compared with DECAF, BAP-65, CURB-65, and APACHE II score in another multicenter cohort.

Results: Five variables were identified as independent predictors for in-hospital death in APCOPD patients admitted to ICU, and a corresponding risk score (PD-ICU score) was established, which was composed of procalcitonin >0.5 μg/L, diastolic blood pressure <60 mm Hg, need for invasive mechanical ventilation, disturbance of consciousness, and blood urea nitrogen >7.2 mmol/L. Patients were classified into three risk categories according to the PD-ICU score. The in-hospital mortality of low-risk, intermediate-risk, and high-risk patients was 0.3%, 7.3%, and 27.9%, respectively. PD-ICU score displayed excellent discrimination ability with an area under the receiver-operating characteristic curve (AUC) of 0.815 in the derivation cohort and 0.754 in the validation cohort which outperformed other prognostic models.

Conclusion: We derived and validated a simple and clinician-friendly prediction model (PD-ICU score) for in-hospital mortality among AECOPD patients admitted to ICU. With good performance and clinical practicability, this model may facilitate early risk stratification and optimal decision-making among these patients.

Introduction: Over the last decade, the number of patients receiving home mechanical ventilation (HMV) has increased significantly, which has led to a limited availability of specialist centres, not least due to the scarcity of healthcare professionals. This situation was exacerbated by the COVID-19 pandemic. It is therefore assumed that the repurposing of resources has led to an aggravated change in the healthcare structure in HMV.

Methods: This descriptive observational study analysed the Operation and Procedure Classification Codes for patients receiving HMV from 2008 to 2022. The data were provided by the Federal Statistical Office of Germany. Data were additionally analysed with respect to geographical distribution and ventilation status.

Results: A total of 737,770 datasets were analysed (mean age in 2020: 66.5 years). There was a steady increase in HMV initiations (+6%) and controls (+9%) per year before the pandemic (2008-2019). Patient admissions during the pandemic revealed a 28% decrease, with the largest decrease in invasive ventilation (IV) follow-up visits (2019: 3,053; 2020: 2,199; -39%), while the number of IV initiations remained stable. There was a 19% decrease in the number of non-IV initiations in 2020 (16,919 vs. 14,227) and a 32% decrease in the number of follow-ups (45,812 vs. 34,813) in comparison with 2019.

Conclusion: The pandemic has led to a significant decline of inpatient admissions for patients receiving HMV. This decline was most pronounced in the first year of the pandemic. Control visits in particular did not reach the pre-pandemic level. This is an indication of the ongoing change in the healthcare landscape as a result of the pandemic.