Respirology : official journal of the Asian Pacific Society of Respirology
-
During continuous positive airway pressure (CPAP) treatment, some patients with obstructive sleep apnoea syndrome (OSAS) require an oronasal mask (ONM) to prevent excessive mouth leakage. Factors contributing to sleep-related mouth opening under CPAP treatment remain known. We compared mouth opening during sleep in patients treated with CPAP by nasal mask (NM) versus ONM. ⋯ After several months of CPAP treatment, some patients using ONM persist in keeping their mouths open at night. Nasal obstruction and male gender contribute to this phenomenon.
-
Review Meta Analysis
Is COPD associated with increased mortality and morbidity in hospitalized pneumonia? A systematic review and meta-analysis.
This review aimed to investigate whether chronic obstructive pulmonary disease (COPD) is associated with increased mortality and morbidity in patients hospitalized with community-acquired pneumonia (CAP). EMBASE, PubMed and Web of Science were searched for cohort studies and case-control studies investigating the impact of COPD on CAP. The primary outcome was all-cause mortality, and secondary outcomes included length of hospital stay, intensive care unit (ICU) admission and need for mechanical ventilation. ⋯ COPD was not associated with longer hospital stay (MD, 0.11; 95% CI: -0.42 to 0.64; P = 0.68; I(2) = 21%), more frequent ICU admission (RR, 0.97; 95% CI: 0.70-1.35; P = 0.87; I(2) = 65%), and more need for mechanical ventilation (RR 0.91, 95% CI: 0.71-1.16; P = 0.44; I(2) = 4%). The current available evidence indicates that COPD may not be associated with increased mortality and morbidity in patients hospitalized with CAP. This conclusion should be re-evaluated by prospective population-based cohort studies.
-
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrotic lung disease associated with high morbidity and poor survival. Characterized by substantial disease heterogeneity, the diagnostic considerations, clinical course and treatment response in individual patients can be variable. ⋯ Although the search for candidate biomarkers remains in its infancy, attractive targets such as MUC5B and MPP7 have already been validated in large cohorts and have demonstrated their potential to improve clinical predictors beyond that of routine clinical practices. The discovery and implementation of future biomarkers will face many challenges, but with strong collaborative efforts among scientists, clinicians and the industry the ultimate goal of personalized medicine may be realized.
-
Randomized Controlled Trial
Association between intraoperative ventilator settings and plasma levels of soluble receptor for advanced glycation end-products in patients without pre-existing lung injury.
The soluble form of the receptor for advanced glycation end-products (sRAGE) is elevated and correlated with severity in patients with acute respiratory distress syndrome (ARDS). The impact of ventilator settings on plasma levels of sRAGE, in patients with or without pre-existing lung injury, remains under-investigated to date. Our objective was to assess the effects of a lung-protective ventilation strategy (combining low tidal volume, positive end-expiratory pressure and recruitment maneuvers), as compared with a non-protective approach (with high tidal volume and zero end-expiratory pressure), on plasma levels of sRAGE in patients without lung injury undergoing major abdominal surgery. ⋯ A lung-protective ventilation strategy decreased plasma sRAGE in patients without lung injury undergoing major abdominal surgery compared with the patients with non-protective ventilation. This intraoperative decrease could reflect a lesser degree of epithelial injury.
-
Clinical impact of early bronchoscopy in mechanically ventilated patients with aspiration pneumonia.
A handful of studies have reported that bronchoscopies influence the clinical outcome of mechanically ventilated patients with aspiration pneumonia. The purpose of the present study is to elucidate the therapeutic role of early bronchoscopy in patients with aspiration who are mechanically ventilated. ⋯ Early bronchoscopy could benefit the clinical outcomes of mechanically ventilated patients with aspiration pneumonia.