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Heart Rate Characteristics Predict Risk of Mortality in Preterm Infants in Low and High Target Oxygen Saturation Ranges 心率特征预测低目标氧饱和度范围和高目标氧饱和度范围早产儿的死亡风险
Pub Date : 2024-03-14 DOI: 10.1183/23120541.00782-2023
William E. King, U. Sanghvi, N. Ambalavanan, Vivek V Shukla, C. Travers, R. Schelonka, Clyde Wright, Waldemar A. Carlo
The Neonatal Oxygenation Prospective Meta-analysis found that in infants <28 weeks gestational age, targeting an oxygen saturation (SpO2) range of 85–89%versus91–95% resulted in lower rates of retinopathy of prematurity (ROP) but increased mortality. We aimed to assess the accuracy of the heart rate characteristics index (HRCi) to assess the dynamic risk of mortality among infants managed with low and high target SpO2ranges.The SUPPORT and HRCi datasets from one center where both RCTs overlapped were linked. We examined the maximum daily HRCi (MaxHRCi24) to predict death among patients randomized to the lower and higher SpO2groups by generating predictiveness curves and calculating model performance metrics, including AUROC at prediction windows from 1–60 days. Cox proportional hazards models tested whether MaxHRCi24 was an independent predictor of death. We also conducted a moderation analysis.There were 84 infants in the merged dataset. MaxHRCi24 predicted death in subjects randomized to lower target SpO2, with area under the receiver operating characteristic curve (AUROCs 0.79–0.89) depending upon the prediction window, and higher target SpO2(AUROCs 0.82–0.91). MaxHRCi24 was an important additional predictor of death in multivariable modeling. In moderation analysis, in a model that also included demographic predictor variables, the individual terms and the interaction term between MaxHRCi24 and target SpO2range all predicted death.Associations between HRCi and mortality, at low and high SpO2target ranges, suggest that future research may find HRCi metrics helpful to individually optimize target oxygen saturation ranges for hospitalized preterm infants.
新生儿氧合前瞻性荟萃分析发现,对于胎龄小于 28 周的婴儿,目标血氧饱和度 (SpO2) 范围为 85-89% 与 91-95% 相比,早产儿视网膜病变 (ROP) 发生率较低,但死亡率增加。我们旨在评估心率特征指数(HRCi)的准确性,以评估采用低目标 SpO2 范围和高目标 SpO2 范围管理的婴儿的动态死亡风险。我们通过生成预测性曲线和计算模型性能指标(包括 1-60 天预测窗口的 AUROC),检验了最大日 HRCi(MaxHRCi24)在随机分配到低 SpO2 组和高 SpO2 组的患者中预测死亡的能力。Cox 比例危险模型检验了 MaxHRCi24 是否是独立的死亡预测因子。合并数据集中有 84 名婴儿。MaxHRCi24可预测随机目标SpO2较低受试者的死亡,根据预测窗口的不同,接收者操作特征曲线下面积(AUROCs 0.79-0.89)和目标SpO2较高受试者的死亡(AUROCs 0.82-0.91)。在多变量模型中,MaxHRCi24 是预测死亡的另一个重要指标。在一个还包括人口统计学预测变量的模型中,单个项和 MaxHRCi24 与目标 SpO2 范围之间的交互项都能预测死亡。在低和高 SpO2 目标范围内,HRCi 与死亡率之间的关联表明,未来的研究可能会发现 HRCi 指标有助于单独优化住院早产儿的目标血氧饱和度范围。
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引用次数: 0
Hypercapnia is not excluded by normoxia in neuromuscular disease patients: implications for oximetry 神经肌肉疾病患者的高碳酸血症不能通过正常氧排除:对血氧饱和度的影响
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00927-2023
Emma Gray, C. Menadue, Amanda Piper, Keith Wong, Matthew Kiernan, Brendon J. Yee
Pulse oximetry is widely used in the assessment of chronic respiratory failure (CHRF) in neuromuscular disease (NMD) patients. CHRF is the major cause of morbidity and mortality, necessitating early diagnosis and intervention. Guidelines suggest an arterial blood gas (ABG) is indicated if oxygen saturations (SpO2)≤94% in the absence of lung disease. However, hypercapnia with normoxia (SpO2≥95%) has been observed on ABGs of patients with NMD, in particular those with motor neurone disease (MND).A single-centre retrospective audit of room-air ABGs in stable hypercapnic chronic respiratory failure (CHRF) patients from 1990–2020 was performed. Patients with parenchymal lung disease were excluded. Patients were grouped into three main categories: non-NMD, other-NMD and MND.Two-hundred and ninety-seven ABGs with hypercapnia from 180 patients with extrinsic restrictive lung disease were analysed. No patients with non-NMD, 54% of other-NMD and 36% of MND patients demonstrated hypercapnia with normoxia (χ261.33; p<0.001). The potential mechanism is proposed to be a difference in calculated respiratory quotient (RQ). If the A-a gradient is assumed to be normal, the calculated RQ was significantly higher in MND patients and other-NMD patients compared with non-NMD patients (estimated-marginal-mean 0.99 [95%CI 0.94–1.03]; 0·86 [95%CI 0.76–0.96]; 0·73 [95%CI 0.63—0.83] respectively; p<0.001) by mixed-model analysis.Hypercapnia is not excluded with normal oximetry in NMD patients and may be due to an elevated RQ. This has implications in the diagnosis and monitoring of respiratory insufficiency in NMD patients with oximetry alone.Dr Emma Gray received an NHMRC Postgraduate Scholarship.
脉搏血氧仪被广泛用于评估神经肌肉疾病(NMD)患者的慢性呼吸衰竭(CHRF)。慢性呼吸衰竭是发病和死亡的主要原因,因此必须及早诊断和干预。指南建议,在无肺部疾病的情况下,如果血氧饱和度(SpO2)≤94%,则应进行动脉血气(ABG)检查。然而,在 NMD 患者,尤其是运动神经元疾病(MND)患者的 ABG 中观察到了高碳酸血症与正常氧合(SpO2≥95%)。患有肺实质疾病的患者被排除在外。患者被分为三大类:非 NMD、其他 NMD 和 MND。分析了 180 名外在限制性肺部疾病患者的 297 份高碳酸血症 ABG。没有非 NMD 患者、54% 的其他 NMD 患者和 36% 的 MND 患者在常氧状态下出现高碳酸血症(χ261.33;P<0.001)。其潜在机制是计算出的呼吸商(RQ)不同。如果假定 A-a 梯度正常,通过混合模型分析,MND 患者和其他 NMD 患者的计算 RQ 明显高于非 NMD 患者(估计边际平均值分别为 0.99 [95%CI 0.94-1.03];0-86 [95%CI 0.76-0.96];0-73 [95%CI 0.63-0.83];p<0.001)。Emma Gray 博士获得了 NHMRC 研究生奖学金。
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引用次数: 0
Pneumothorax as a complication of dry needling technique 干针技术的并发症--气胸
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00156-2024
Jan S.B. Bontinck, Cathelijne Lyphout, Thomas L.A. Malfait
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引用次数: 0
Cardiopulmonary exercise testing and body composition 心肺运动测试和身体成分
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00970-2023
Per Karlsson, Lars Lind, Karl Michaëlsson, Andrei Malinovschi
The cardiopulmonary exercise test (CPET) evaluates cardiopulmonary function. In light of the obesity epidemic, it is important to understand how body composition affects interpretation of CPET results.to assess the relationship between CPET measures, others than peak oxygen uptake, and body composition.A total of 330 participants, aged 50 years, performed both a CPET and a Dual-energy x-ray absorptiometry (DXA). From CPET, peak exercise respiratory exchange ratio (RER), ventilatory efficiency (VE/VCO2slope) and work efficiency (ΔVO2/ΔWR) were recorded. Pearson's correlation was used to assess the association between CPET measures and selected body composition measures including body mass index (BMI), waist circumference, fat mass, lean mass, body fat percentage and percentage trunk fat to fat mass. All analyses were done stratified by sex. A p-value<0.05 defined statistical significance.RER was negatively correlated with body composition measures; the strongest correlation was observed with waist circumference in females (r=−0.36). VE/VCO2slope had no significant correlations with any body composition measures.ΔVO2/ΔWR was positively correlated with the body composition measures; the strongest correlation was observed with BMI (r=0.24). The additive role of percentage body fat and percentage trunk fat were studied in a linear regression model using waist circumference and BMI to predict the above-named CPET measures and no additive role was found.RER andΔVO2/ΔWR may be influenced by body composition while VE/VCO2slope is not affected. Adiposity measures from DXA add no additional explanatory value to the CPET measures.
心肺运动测试(CPET)评估心肺功能。共有 330 名 50 岁的参与者进行了 CPET 和双能 X 射线吸收测定(DXA)。CPET 记录了峰值运动呼吸交换比(RER)、通气效率(VE/VCO2slope)和工作效率(ΔVO2/ΔWR)。采用皮尔逊相关性来评估 CPET 指标与选定的身体成分指标(包括体重指数 (BMI)、腰围、脂肪量、瘦肉量、体脂百分比和躯干脂肪占脂肪量的百分比)之间的关联。所有分析均按性别进行分层。RER与身体成分指标呈负相关;女性与腰围的相关性最强(r=-0.36)。ΔVO2/ΔWR与身体成分指标呈正相关;与体重指数的相关性最强(r=0.24)。在使用腰围和体重指数预测上述 CPET 指标的线性回归模型中,研究了体脂百分比和躯干脂肪百分比的相加作用,结果没有发现相加作用。来自 DXA 的脂肪测量值对 CPET 测量值没有额外的解释价值。
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引用次数: 0
Transition of care from adolescence to early adulthood in severe asthmatic patients treated with omalizumab in real-life 使用奥马珠单抗治疗的重症哮喘患者从青春期到成年早期的护理过渡实况
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00976-2023
Camille Taillé, Marc Humbert, Arnaud Bourdin, C. Thonnelier, Audrey Lajoinie, Jules Chassetuillier, Mathieu Molimard, Antoine Deschildre
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引用次数: 0
Mortality prevention as the center of COPD management 将预防死亡作为慢性阻塞性肺病管理的核心
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00850-2023
A. Papaioannou, G. Hillas, S. Loukides, Theodoros Vassilakopoulos
COPD is a major healthcare problem and cause of mortality worldwide. COPD patients at increased mortality risk are those that are more symptomatic, have lower lung function and lower DLCO, have decreased exercise capacity, belong to the emphysematous phenotype and those who have concomitant bronchiectasis. Also mortality risk seems to be greater in patients who experience COPD exacerbations and in those who suffer from concomitant cardiovascular and/or metabolic diseases. To predict the risk of death in COPD patients several composite scores have been created using different parameters. In the previous years, large studies (also called Mega-Trials) have evaluated the efficacy of different therapies on COPD mortality, but until recently only non-pharmaceutical interventions have proven to be effective. However, recent studies on fixed combinations of triple therapy (long-acting beta agonists, long-acting muscarinic antagonists and inhaled corticosteroids) have provided encouraging results, showing for the first time a reduction in mortality compared to dual therapies. The aim of the present review is to summarize available data regarding mortality risk in COPD patients and to describe pharmacologic therapies that have shown effectiveness in reducing mortality.
慢性阻塞性肺病是全球主要的医疗问题和死亡原因。慢性阻塞性肺病患者中,症状较重、肺功能较差、DLCO 较低、运动能力下降、肺气肿表型以及合并支气管扩张的患者死亡风险较高。此外,慢性阻塞性肺病病情加重的患者以及合并心血管和/或代谢疾病的患者的死亡风险似乎更大。为了预测慢性阻塞性肺病患者的死亡风险,人们使用不同的参数创建了多个综合评分。前些年,一些大型研究(也称为大型三项研究)评估了不同疗法对慢性阻塞性肺病死亡率的疗效,但直到最近,只有非药物干预措施被证明是有效的。不过,最近关于三联疗法(长效β受体激动剂、长效毒蕈碱拮抗剂和吸入皮质类固醇)固定组合的研究结果令人鼓舞,首次显示与双重疗法相比,死亡率有所下降。本综述旨在总结有关慢性阻塞性肺病患者死亡风险的现有数据,并介绍在降低死亡率方面具有疗效的药物疗法。
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引用次数: 0
Long-term associations of PM1vs. PM2.5and PM10with asthma and asthma-related respiratory symptoms in middle-aged and elderly population 中老年人群中 PM1、PM2.5 和 PM10 与哮喘及哮喘相关呼吸道症状的长期关系
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00972-2023
Xue-yan Zheng, Shu-jun Guo, Jian-xiong Hu, Rui-lin Meng, Yan-jun Xu, Yun-hong Lv, Ye Wang, N. Xiao, Chuan Li, Xiao-jun Xu, De-jian Zhao, Hong-ye Zhou, Jia-hui He, Xiao-min Tan, Jing Wei, Li-feng Lin, Wei-jie Guan
Few studies have compared the associations between long-term exposures to particulate matters (aerodynamic diameter ≤1, 2.5 and 10 µm: PM1, PM2.5and PM10) and asthma and asthma-related respiratory symptoms.To compare the strength of the above-mentioned associations in middle-aged and elderly adults.We calculated the mean 722-day personal exposure estimates of PM1, PM2.5and PM10at 1 km×1 km spatial resolution between 2012 and 2019 at individual levels fromChina High Air Pollutantsdatasets. Using logistic regression model, we presented the associations as odds ratios (ORs) and 95% confidence intervals (95%CIs), for each interquartile range (IQR) increase in PM1/PM2.5/PM10concentration. Asthma denoted a self-reported history of physician-diagnosed asthma, or wheezing in the preceding 12 months.We included 7371 participants inChronic Obstructive Pulmonary Diseases Surveillancefrom Guangdong, China. Each IQR increase in PM1, PM2.5and PM10was associated with a greater odds [OR (95%CI)] of asthma [PM1: 1.22 (1.02, 1.45); PM2.5: 1.24 (1.04, 1.48); PM10: 1.30 (1.07, 1.57)], wheeze [PM1: 1.27 (1.11, 1.44); PM2.5: 1.30 (1.14, 1.48); PM10: 1.34 (1.17, 1.55)], persistent cough [PM1: 1.33 (1.06, 1.66); PM2.5: 1.36 (1.09, 1.71); PM10: 1.31 (1.02, 1.68)] and dyspnea [PM1: 2.10 (1.84, 2.41); PM2.5: 2.17 (1.90, 2.48); PM10: 2.29 (1.96, 2.66)]. Sensitivity analysis results were robust after excluding individuals with a family history of allergy. Associations of PM1, PM2.5and PM10with asthma and asthma-related respiratory symptoms were slightly stronger in males.Long-term exposure to PM is associated with increased risks of asthma and asthma-related respiratory symptoms.
为了比较中老年人长期暴露于颗粒物(空气动力学直径≤1、2.5和10微米:PM1、PM2.5和PM10)与哮喘和哮喘相关呼吸道症状之间的关系,我们从中国空气污染物高浓度数据集中计算了2012年至2019年期间个人平均722天暴露于PM1、PM2.5和PM10的估计值,空间分辨率为1千米×1千米。利用逻辑回归模型,我们以几率比(ORs)和 95% 置信区间(95%CIs)表示 PM1/PM2.5/PM10 浓度每增加一个四分位数区间(IQR)的相关性。我们纳入了中国广东省慢性阻塞性肺病监测的 7371 名参与者。PM1、PM2.5 和 PM10 每增加一个 IQR 值,哮喘[PM1:1.22(1.02,1.45);PM2.5:1.24(1.04,1.48);PM10:1.30(1.07,1.57)]、喘息[PM1:1.27(1.11,1.44);PM2.5:1.30(1.14,1.48);PM10:1.34(1.17,1.55)]、持续咳嗽[PM1:1.33(1.06,1.66);PM2.5:1.36(1.09,1.71);PM10:1.31(1.02,1.68)]和呼吸困难[PM1:2.10(1.84,2.41);PM2.5:2.17(1.90,2.48);PM10:2.29(1.96,2.66)]。在排除有过敏家族史的个体后,敏感性分析结果是可靠的。PM1、PM2.5和PM10与哮喘和哮喘相关呼吸道症状的相关性在男性中稍强。
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引用次数: 0
Prematurity-associated lung disease: Is it asthma? 早产相关肺病:是哮喘吗?
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00145-2024
Tiffany K. Bradshaw, Elizabeth Smith, R. Urs, D. Evans, N. Hemy, Shannon J. Simpson
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引用次数: 0
Motivation and preferences for learning of patients with COPD or asthma and their significant others in pulmonary rehabilitation: a qualitative study 慢性阻塞性肺病或哮喘患者及其重要他人在肺康复中的学习动机和偏好:定性研究
Pub Date : 2024-03-07 DOI: 10.1183/23120541.01021-2023
A. Muijsenberg, S. Haesevoets, S. Houben-Wilke, Jan Tatousek, Joyca Lacroix, M. Spruit, D. Janssen
In depth understanding of educational needs from the perspective of the learners in pulmonary rehabilitation (PR) is lacking. To improve learning in PR, understanding of factors that induce or enhance intrinsic motivation in both patients and their significant others is needed. Therefore, this study aims to gain in-depth understanding of what motivates patients with COPD and asthma referred for PR and their significant others to learn and what their preferences are for education.For this qualitative study, a sample was taken from a previous quantitative study. Data was collected through a one-time face-to-face semi-structured interview. The interviews were transcribed and independently analysed by two researchers using thematic analyses.Twelve patients and four significant others (56% female; age: 63±11 years) have been interviewed. Participants expressed a variety of information needs and learning preferences. Subthemes that emerged within the theme of motivation for learning were: 1) curiosity, such as knowledge gaps and hope for new information; and 2) values and goals, such as own health, caring for loved ones and spending time with family.To enhance intrinsic motivation for learning within PR, autonomy of individuals should be supported by offering several learning topics and education adapted to preferences, while curiosity should be fostered by targeting information needs. Moreover, health education programs should match with the personal values and goals of individuals, such as own health, caring for loved ones and spending time with family.
目前还缺乏从肺康复(PR)学习者的角度对教育需求的深入了解。为了改善肺康复学习,需要了解诱发或增强患者及其重要他人内在动机的因素。因此,本研究旨在深入了解慢性阻塞性肺病(COPD)和哮喘转诊为肺康复的患者及其重要他人的学习动机以及他们对教育的偏好。数据是通过一次性面对面半结构化访谈收集的。访谈内容由两名研究人员进行誊写,并使用主题分析法对访谈内容进行独立分析。参与者表达了各种信息需求和学习偏好。在学习动机这一主题下出现的次主题有1) 好奇心,如知识差距和对新信息的希望;以及 2) 价值观和目标,如自身健康、照顾亲人和与家人共度时光。为增强公共关系中的内在学习动机,应通过提供多个学习主题和适应偏好的教育来支持个人的自主性,同时应通过满足信息需求来培养好奇心。此外,健康教育计划应符合个人的价值观和目标,如自身健康、照顾亲人和与家人共度时光。
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引用次数: 0
European Respiratory Society International Congress, Milan, 2023: Highlights from the Assembly 1 – Respiratory clinical care and physiology 欧洲呼吸学会国际大会,米兰,2023 年:大会亮点 1 - 呼吸系统临床护理和生理学
Pub Date : 2024-03-07 DOI: 10.1183/23120541.00178-2024
Apolline Gonsard, E. Mekov, Sarah Barron, Giorgio Castellana, Elene Khurtsidze, A. Vontetsianos, Francesca Pennati, P. Sivapalan, Lorna E. Latimer, Mathieu Marillier, C. Hui, G. Kaltsakas, S. Kolekar, Guido Vagheggini, Cláudia Vicente, David Drummond, V. Poberezhets, Sam Bayat, F. Franssen, Ioannis Vogiatzis, Thomas Gille
It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, clinical trials and qualitative research that were presented during the 2023 European Respiratory Society International Congress within the sessions from the five groups of the Assembly 1 – Respiratory clinical care and physiology. Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging.
紧跟呼吸医学领域的所有临床和科学进展是一项挑战。本文概述了在 2023 年欧洲呼吸学会国际大会期间,在大会 1--呼吸临床护理和生理学五个小组的会议上所做的基于实验室的科学、临床试验和定性研究。文章从临床问题、康复和慢性病护理、全科实践和初级保健、电子/移动健康(电子健康/移动医疗)、临床呼吸生理学、运动和功能成像等广泛的主题中选取了部分演讲内容进行总结。
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引用次数: 0
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ERJ Open Research
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