Respiration最新文献

German recommendations for the diagnosis of hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, were last published in 2007. The current S2k Guideline for the Diagnosis and Treatment of Hypersensitivity Pneumonitis replaces these diagnostic recommendations. They were supplemented by the aspect of chronic, and in particular of the chronic fibrotic phenotype of HP, and also, as the first HP guideline, include treatment recommendations. Based on current scientific evidence and on expert opinion, 12 consensus recommendations were developed. They include important statements summarizing the diagnostic process, the treatment indication and therapeutic strategies for patients with HP. Particular emphasis was placed on the different clinical courses (acute and chronic) and their characteristics (inflammatory and/or fibrotic pattern), which present differential diagnostic challenges and ultimately result in different treatment approaches. In addition to general information (diagnosis, classification, clinical disease course, epidemiology, pathogenesis, risk factors, prognosis, and special aspects associated with occupational disease), the guideline will present the various clinical disease entities of HP, some in detail, others in tabular form. A major focus is on the various diagnostic steps and the different treatment approaches. The background information serves to provide a deeper understanding and inform the implementation of the recommendations. In particular, other current international guidelines for the diagnosis of HP as well as German guidelines for the diagnosis of interstitial lung diseases (ILDs) (Leitlinien zur Diagnostik interstitieller Lungenerkrankungen) in general and for the pharmacotherapy of fibrotic ILDs were integrated and considered in this guideline.

Introduction: Non-vitamin K antagonist oral anticoagulants (NOACs) increase the risk of bleeding during invasive procedures such as bronchoscopy. To mitigate this risk, NOACs are typically held before bronchoscopy. Current guidelines for discontinuing NOACs are based on drug half-lives and recommendations from similar invasive procedures. This study aimed to evaluate the safety of our local protocols for pausing NOAC therapy prior to bronchoscopy.

Methods: We performed a retrospective review of patients treated with NOACs who underwent bronchoscopy with invasive sampling in 2023. We adhered to local guidelines for NOAC discontinuation before procedures with a high bleeding risk. We documented bleeding incidents during bronchoscopy and any potential thromboembolic events, comparing these outcomes with a control group of 75 patients on acetylsalicylic acid (ASA) and 77 patients not on any anticoagulant (ACT) or antiplatelet (APT) therapy.

Results: Out of 1,300 patients who had bronchoscopy in 2023, 100 were on NOACs (48 on rivaroxaban, 36 on apixaban, 12 on dabigatran, and 4 on edoxaban). We further analyzed 75 patients who had invasive sampling: transbronchial biopsy in 49; bronchial biopsy in 12; EBUS-guided transbronchial needle aspiration in 42; and conventional TBNA in 18. Mild to moderate bleeding occurred in 9 of these 75 patients (12%) receiving NOACs, compared to 11 of 75 patients (14.7%) on ASA and 7 of 77 patients (9.1%) without ACT or APT therapy. Bleeding was observed in patients with either lung cancer (n = 16) or interstitial lung disease (n = 10), with one exception. There was no significant association between bleeding and factors such as age, platelet count, or INR levels. No severe bleeding or thromboembolic events were reported in any of the groups.

Conclusion: Following local recommendations for NOAC discontinuation before bronchoscopy is effective in minimizing complications and ensuring patient safety during invasive procedures.

Introduction: People with post-COVID-19 condition (PCC) suffer from a wide range of symptoms, including anxiety. Studies have already shown that cranial electrotherapy stimulation (CES) has a positive effect on anxiety in anxious people. This randomised, controlled, double-blind, single-centre pilot study aimed to investigate the effects of CES as an adjunctive therapy during rehabilitation on anxiety symptoms in people with PCC.

Methods: Adults with PCC were randomised to an intervention group with rehabilitation and CES (100 μA) or a control group with rehabilitation and sham stimulation. CES was applied via electrodes to the earlobes for 60 min daily for 3 weeks. The Beck Anxiety Inventory (BAI) score was collected at baseline and at discharge.

Results: Forty people with PCC completed the trial. We found that both groups with (n = 20) and without CES (n = 20) improved significantly in terms of change in the BAI score (CES_group: p = 0.037; sham_group: p = 0.018), with no difference between groups (p = 0.82). In a subgroup analysis of anxious patients only (BAI: ≥16 points, baseline score), both groups (CES_anxious: n = 10, sham_anxious: n = 10) significantly improved the BAI score (CES_anxious: p = 0.008; sham_anxious: p = 0.002) with no difference between groups (p = 0.69).

Conclusion: This study suggests that CES had no additional benefit on anxiety symptoms during rehabilitation in people with PCC.

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: 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: Ultrasound-guided trans-thoracic needle biopsy (US-TTNB) is a method of choice for the diagnostic management of peripheral lung lesions and pleural masses for pulmonologists. If complication risk factors and diagnostic yield have been well reported for CT-guided biopsies, publications for US-TTNB in this field are very scarce.

Methods: The primary objective of this study was to describe the diagnostic yield of US-TTNB carried out by pulmonologists defined by a definitive histopathological diagnosis. Secondary objectives were to identify factors that may influence diagnostic yield and to describe complications of this procedure. Between September 2015 and December 2022, charts of consecutive patients presenting peripheral lesion with pleural contact and having undergone US-TTNB were retrospectively analyzed. ROC curves were performed to assess the probability of having a contributing biopsy (definitive histology) depending on scannographic measurements and the number of punctures. Univariate and then multivariate analyses were performed to look for variables associated with complications.

Results: One hundred and fifty-nine patients were enrolled in this study. Among them, diagnosis was obtained for 140 patients (88% success rate). The histology was in favor of a neoplastic process in 96% of cases (135/140). Analysis of the ROC curves showed that the depth of the lesion (AUC 75%; 95% CI: 65-85; cut-off 3.0 cm), the width of the lesion (AUC 73%; 95% CI: 63-86; cut-off 3.9 cm), the pleural contact (AUC 68%; 95% CI: 57-80; cut-off 3.8 cm), and the number of biopsies (AUC 70%; 95% CI: 59-81; cut-off 3 biopsies) were the variables associated with diagnostic yield. Complications occurred for 27 patients (17%), mainly pneumothorax (6%), hemoptysis (6%), and sepsis (6%). Univariate analysis showed a significant association between pneumothorax and lesion depth (OR 0.68; 95% CI: 0.65-0.92; p = 0.03) with a predicted probability >5% for a depth <4 cm according to general linear model analysis. Univariate and multivariate analysis revealed a significant association between the number of biopsies and the risk of sepsis (OR 1.90; 95% CI: 1.19-3.26; p = 0.01) with a predicted probability >5% for more than 4 biopsies.

Conclusion: US-TTNB is a reliable diagnostic procedure that can be performed by pulmonologists. The depth, width, pleural contact of the lesion, and the number of biopsies are key variables associated with diagnostic yield. The depth of the lesion is associated with the risk of pneumothorax, and the number of biopsies with the risk of pulmonary sepsis.

Introduction: Local anaesthetic thoracoscopy (LAT) is widely available in the UK. It is often the investigation of choice for unexplained exudative pleural effusions. There are no agreed national standards regarding LAT, with many sites following locally developed guidelines. The last survey of UK practice was in 2017.

Methods: An electronic survey was circulated to UK Pleural Society (UKPS) members and through direct communication with centres known to be undertaking LAT. Invited centres were requested to distribute the survey further.

Results: Thirty-seven responses were included. LAT remains the preferred investigation for an undiagnosed exudative pleural effusion (32/37, 87%). The number of trained thoracoscopists ranged from 1 to 6. Thirty centres (81%) had dedicated thoracoscopy lists with varying frequency. Nineteen (51%) centres routinely admitted patients post-thoracoscopy (compared to 76% in 2017). Thirty centres (81%) did not routinely administer antibiotics. Thirty-five centres (95%) routinely used sedation, the commonest agent being midazolam, typically in combination with an opiate. Eleven centres (30%) utilised other pre-medications, while 8/37 (22%) of centres administered intravenous fluids. Where a minimal effusion is present 27/37 (73%) would induce a pneumothorax. Eleven (29%) centres would perform LAT for pleural infection. Only 11/37 (30%) of centres have on-site thoracic surgical support.

Conclusions: There is wide variation in LAT practice among UK centres. These results support the need for identifying best practice and standardisation of LAT practices, with outcome reporting. These survey results will form the basis of applications to the national and international respiratory societies to develop relevant standards.

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and contributes significantly to reduced quality of life due to symptoms such as dyspnea and exercise intolerance. Eccentric cycling exercise (ECC) has shown potential as an alternative to conventional concentric cycling exercise (CON) in cardiopulmonary disease, including COPD, as it has a lower metabolic demand and potentially allows for higher exercise intensity with less perceived exertion. We aimed to compare ventilatory and circulatory responses of COPD patients between ECC and CON at identical submaximal workloads.

Methods: In a randomized-controlled crossover trial, 17 COPD patients (6 female, mean ± SD age 67 ± 7 years) completed identical submaximal stepwise incremental cycling tests using ECC and CON, each step increasing by 10 W. The main outcome was oxygen uptake (V˙O2). Additional outcomes were breath-by-breath ergospirometric measurements including minute ventilation (V˙E) and hemodynamics by echocardiography at each step.

Results: At a mean end-exercise intensity of 41.3 ± 3.5 W, ECC lowered V˙O2 by -122 mL/min (-25%, 95% CI: -213 to -47, p = 0.005) and V˙E by -5.7 L/min (-29%, 95% CI: -10.0 to -1.6, p = 0.012) compared to CON. Perceived dyspnea and leg fatigue did not differ. A trend toward reduced strain on the right ventricle was observed in ECC (37 ± 13 mm Hg ECC vs. 48 ± 7 mm Hg CON), but this was not significant (p = 0.063). No adverse events occurred.

Conclusion: ECC allowed COPD patients to exercise at the same workload but with a lower metabolic and ventilatory demand compared to CON, suggesting it has the potential to further improve exercise capacity in pulmonary rehabilitation.

Introduction: Bronchial Dieulafoy's disease (BDD) comprises rare vascular malformations. This study analyzes a series of BDD patients diagnosed through combined bronchial computed tomography arteriography (CTA) and bronchoscopy, addressing critical gaps in diagnostic standardization and therapeutic decision-making.

Methods: This was a retrospective review of patients who underwent CTA and bronchoscopy for mild to massive and unexplained recurrent hemoptysis in two centers during a 6-year period.

Results: Thirty-six patients were diagnosed with BDD by bronchial CTA and bronchoscopy. Abnormal vessels were observed by CTA in all 36 patients; twisted vessels protruding into the bronchial lumen were found in 14 patients. Mucosal eminence lesions in the ipsilateral lobar/segmental bronchus were detected by white light bronchoscopy in all patients. Bronchial artery embolization (BAE) was performed in 10 patients, and endobronchial intervention was attempted in 18 patients as the initial treatment. Eight patients received application of antibiotics and hemostatic drugs, only. Recurrent hemoptysis occurred in 1 patient.

Conclusion: Vascular disease was the main cause of large to massive hemoptysis. CTA is a noninvasive method that could be used for first-line screening for bronchial vascular malformations. Bronchoscopic procedures could confirm the diagnosis of BDD. BAE is often the first choice, clinically, owing to the invasiveness of thoracic surgery and the patient's status. Bronchoscopic interventional therapy is an effective complement to BAE.

Introduction: Lung cancer screening has increased the detection of peripheral pulmonary lesions (PPLs). Accurate diagnosis for therapy and prognosis is crucial but challenging. Our study compares the safety and efficacy of transbronchial cryobiopsy with two probe diameters and forceps biopsy.

Methods: This single-centre, investigator-initiated, open-label, randomised trial included patients with PPLs who required flexible bronchoscopy with radial endobronchial ultrasound-guided biopsy for histopathological diagnosis. Patients received a forceps biopsy and were randomly assigned to a cryobiopsy with a 1.1-mm (freezing time 7-10 s) or a 1.7-mm cryoprobe (freezing time 4-6 s), respectively. The primary outcome was the diagnostic yield; secondary outcomes included total biopsy size, the proportion of malignant tissue, artefact-free alveolar space percentage, molecular pathology of the specimen, and safety.

Results: Fifty-four patients (66.52 ± 9.81 years; 48.1% male) with a median nodule size of 24 mm (interquartile range 19-30) were included. The overall diagnostic yield was similar in the 1.1-mm and 1.7-mm groups (75.9% vs. 88.0%, p = 0.261), and the specimens obtained with the two different cryoprobes were equal in size, quality, and information about molecular pathology. There was no difference in procedural-related bleeding between the groups (p = 0.847). Compared to forceps biopsies, cryobiopsies had a superior overall diagnostic yield (75.9% vs. 48.1%, p = 0.001) and were better suited for further molecular analysis (p = 0.001).

Conclusion: The 1.1-mm and 1.7-mm cryoprobes displayed comparable diagnostic yield, ability to provide molecular pathology information, and safety. Forceps biopsy was inferior to cryobiopsy in all aspects except safety.

Background: Advances in neonatal and pediatric intensive care have improved patient survival rates, emphasizing the need for respiratory support in cases of chronic respiratory failure, resulting in the establishment of the Turkish National Pediatric Patients Receiving Home Mechanical Ventilation (HMV) Support Registration System in 2023. This study aims to present the initial findings of the registry.

Methods: In this cross-sectional study, epidemiological and demographic data were obtained from the registry and compared between invasive ventilation (IV) and non-IV (NIV) groups.

Results: The study included 952 patients registered from 23 centers with a median (interquartile range) age of 6.0 (3.0-12.0) years. IV support was observed in 51.1% of patients (n = 486). There was no difference in sex between IV and NIV groups, but a significant difference in age, nutrition, mobility status, and education were observed between the subgroups. The largest patient group had neuromuscular disease, with spinal muscular atrophy being the most common primary diagnosis (15.7%). Most of the caregivers (78.7% in the NIV group and 93.8% in the IV group) received formal training before the initiation of HMV.

Conclusion: Turkey's first registry for pediatric HMV patients is introduced. This system helps understand and solve mobility and education issues for these patients in our country. Collaboration with relevant ministries is crucial. In addition, although most of the caregivers have received training before discharge, efforts are still needed to ensure that this rate is 100%. The long-term results will be presented in the future.