The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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The predictive factors for long-term dependency (LTD) on noninvasive ventilation (NIV) immediately after acute hypercapnic respiratory failure (AHRF) have not been identified. The present authors studied 42 patients with chronic obstructive pulmonary disease (COPD) and 58 non-COPD patients successfully treated by NIV for an AHRF episode. Parameters at stable state, at admission for AHRF and during a 1-yr follow-up were compared in patients with or without LTD-NIV at discharge. ⋯ Outcome after 1 yr was poor in COPD patients. Long-term dependency on noninvasive ventilation is not an uncommon situation after resolution of an acute hypercapnic respiratory failure episode, especially in patients with non-chronic obstructive pulmonary disease causes of respiratory failure. The present study raises the need for prospective validation of a weaning protocol in patients managed by noninvasive ventilation for an acute hypercapnic respiratory failure episode.
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Recent studies have reported that the application of thermal energy delivered through a bronchoscope (bronchial thermoplasty) impairs the ability of airways to narrow in response to methacholine. How such altered smooth muscle affects the response of airways to lung inflation may have important clinical implications, particularly as it relates to the abnormal response of asthmatic subjects to lung inflation and deep inspiration. The aim of this study was to examine whether bronchial thermoplasty affected airway distension with lung inflation in relaxed and contracted airways. ⋯ Prior to treatment, the airway pressure-area curves in the two groups of airways were identical. In contrast, the relaxed and contracted airway pressure-area curves in treated airways were shifted upward at all points, showing increased airway area at both 3 and 5 weeks post-treatment. In conclusion, these results show that reducing that amount of functional smooth muscle with bronchial thermoplasty leads to increased airway size in both relaxed and contracted states over a normal range of inflation pressures.
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Review Comparative Study
The dream of a vaccine against tuberculosis; new vaccines improving or replacing BCG?
In the last 10 yrs, work with experimental laboratory models has developed many new vaccine candidates against tuberculosis (TB). They include subunit vaccines, modified bacilli Calmette-Guérin (BCG) and attenuated Mycobacterium tuberculosis. Phase I clinical trials of new TB vaccine candidates have begun for the first time after 80 yrs of use of BCG. ⋯ The goal is a new generation of vaccines effective against respiratory forms of tuberculosis. As a first step, good candidate vaccines able to boost bacille Calmette-Guérin and thereby improve protection could be a reality in the near future. Tuberculosis vaccine candidates, able to replace the currently used bacille Calmette-Guérin and/or make the eradication of tuberculosis feasible, can only be expected in the long-term, and safe live vaccines could be promising candidates.
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Randomized Controlled Trial Comparative Study
Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients.
Presence of a nasogastric tube is a risk factor for the development of ventilator-associated pneumonia (VAP). Alternatively, gastrostomy can be used for administration of enteral feedings. To determine whether early performance of gastrostomy affects frequency of VAP, a randomised, controlled study was carried out in patients mechanically ventilated for stroke or head injury. ⋯ After excluding these subjects, difference in VAP frequency persisted: two out of 16 subjects with gastrostomy had VAP (12.5%) versus eight out of 18 controls (44.4%). There were no differences in duration of hospitalisation or mortality between the two groups. In conclusion, in patients mechanically ventilated for stroke or head injury early gastrostomy is associated with a lower frequency of ventilator-associated pneumonia compared with a nasogastric tube.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised trial of ambulatory oxygen in oxygen-dependent COPD.
Long-term oxygen therapy may limit a patient's ability to remain active and may be detrimental to the rehabilitation process. This study aimed to determine the effect of ambulatory oxygen on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease fulfilling the usual criteria of long-term oxygen therapy. In a 1-yr, randomised, three-period, crossover trial, 24 patients (mean age 68 yrs; mean arterial partial pressure of oxygen at rest 7.1 kPa (53 mmHg)) were allocated to one of the six possible sequences generated by three interventions: 1) standard therapy (home oxygen therapy with an oxygen concentrator only); 2) standard therapy plus as-needed ambulatory oxygen; and 3) standard therapy plus ambulatory compressed air. ⋯ On average, the patients used few ambulatory cylinders (7.5 oxygen cylinders versus 7.4 compressed air cylinders over a 3-month study period). Ambulatory oxygen had no effect on any of the outcomes. In conclusion, the current results do not support the widespread provision of ambulatory oxygen to patients with oxygen-dependent chronic obstructive pulmonary disease.