The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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This study aimed to investigate whether the combination of fibrosis and emphysema has a greater effect than the sum of its parts on functional indices and outcome in idiopathic pulmonary fibrosis (IPF), using visual and computer-based (CALIPER) computed tomography (CT) analysis. Consecutive patients (n=272) with a multidisciplinary IPF diagnosis had the extent of interstitial lung disease (ILD) scored visually and by CALIPER. Visually scored emphysema was subcategorised as isolated or mixed with fibrotic lung. ⋯ Conversely, only isolated emphysema (p<0.0001) reduced gas transfer (DLCO). There is no prognostic impact of emphysema in IPF, beyond that explained by the additive extents of both fibrosis and emphysema. With respect to the location of pulmonary fibrosis, emphysema distribution determines the functional effects of emphysema.
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Randomized Controlled Trial Multicenter Study
Automatic versus manual oxygen administration in the emergency department.
Oxygen is commonly administered in hospitals, with poor adherence to treatment recommendations. We conducted a multicentre randomised controlled study in patients admitted to the emergency department requiring O2 ≥3 L·min-1 Patients were randomised to automated closed-loop or manual O2 titration during 3 h. Patients were stratified according to arterial carbon dioxide tension (PaCO2 ) (hypoxaemic PaCO2 ≤45 mmHg; or hypercapnic PaCO2 >45-≤55 mmHg) and study centre. ⋯ O2 could be weaned at the end of the study in 14.1% versus 4.3% patients in the automated and manual titration group, respectively (p<0.001). O2 duration during the hospital stay was significantly reduced (5.6±5.4 versus 7.1±6.3 days, p=0.002). Automated O2 titration in the emergency department improved oxygenation parameters and adherence to guidelines, with potential clinical benefits.
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Editorial Comment
The paradoxical association between pulmonary embolism and COPD.