BMJ open respiratory research
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BMJ Open Respir Res · Jan 2019
Randomised Ambulatory Management of Primary Pneumothorax (RAMPP): protocol of an open-label, randomised controlled trial.
Pneumothorax is a common clinical problem. Primary spontaneous pneumothorax (PSP) occurs in otherwise fit young patients, but optimal management is not clearly defined and often results in a long hospital stay. Ambulatory treatment options are available, but the existing data on their efficacy are poor. The Randomised Ambulatory Management of Primary Pneumothorax trial is a multicentre, randomised controlled trial comparing ambulatory management with standard care, specifically designed to safely and effectively reduce hospital stay. ⋯ The trial has received ethical approval from the National Research Ethics Service Committee South-Central Oxford A (15/SC/0240).
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BMJ Open Respir Res · Jan 2019
Observational StudyValidation of the Swedish Multidimensional Dyspnea Profile (MDP) in outpatients with cardiorespiratory disease.
Breathlessness is a cardinal symptom in cardiorespiratory disease. An instrument for measuring different aspects of breathlessness was recently developed, the Multidimensional Dyspnea Profile (MDP). This study aimed to validate the MDP in terms of the underlying factor structure, internal consistency, test-retest reliability and concurrent validity in Swedish outpatients with cardiorespiratory disease. ⋯ MDP is a valid instrument for multidimensional measurement of breathlessness in Swedish outpatients across cardiorespiratory diseases.
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BMJ Open Respir Res · Jan 2019
Comparative StudyCryobiopsy versus open lung biopsy in the diagnosis of interstitial lung disease (COLDICE): protocol of a multicentre study.
Transbronchial lung cryobiopsy (TBLC) is a novel, minimally invasive technique for obtaining lung tissue for histopathological assessment in interstitial lung disease (ILD). Despite its increasing popularity, the diagnostic accuracy of TBLC is not yet known. The COLDICE Study (Cryobiopsy versus Open Lung biopsy in the Diagnosis of Interstitial lung disease allianCE) aims to evaluate the agreement between TBLC and surgical lung biopsy sampled concurrently from the same patients, for both histopathological and multidisciplinary discussion (MDD) diagnoses. ⋯ The study is being conducted in accordance with the International Conference on Harmonisation Guideline for Good Clinical Practice and Australian legislation for the ethical conduct of research.
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BMJ Open Respir Res · Jan 2019
Comparative StudyAssessing small airway disease in GLI versus NHANES III based spirometry using area under the expiratory flow-volume curve.
Spirometry interpretation is influenced by the predictive equations defining lower limit of normal (LLN), while 'distal' expiratory flows such as forced expiratory flow at 50% FVC (FEF50) are important functional parameters for diagnosing small airway disease (SAD). Area under expiratory flow-volume curve (AEX) or its approximations have been proposed as supplemental spirometric assessment tools. We compare here the performance of AEX in differentiating between normal, obstruction, restriction, mixed defects and SAD, as defined by Global Lung Initiative (GLI) or National Health and Nutrition Examination Survey (NHANES) III reference values, and using various predictive equations for FEF50. ⋯ If the SAD diagnosis is established by using mean FEF50 LLN or a set number of predictive equations, AEX is able to differentiate well between various spirometric patterns. Using the most common predictive equations (NHANES III and GLI), the diagnostic concordance for functional type and obstruction severity is high.
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BMJ Open Respir Res · Jan 2019
Practice GuidelineGuidelines on the management of acute respiratory distress syndrome.
The Faculty of Intensive Care Medicine and Intensive Care Society Guideline Development Group have used GRADE methodology to make the following recommendations for the management of adult patients with acute respiratory distress syndrome (ARDS). The British Thoracic Society supports the recommendations in this guideline. Where mechanical ventilation is required, the use of low tidal volumes (<6 ml/kg ideal body weight) and airway pressures (plateau pressure <30 cmH2O) was recommended. ⋯ The use of a conservative fluid management strategy was suggested for all patients, whereas mechanical ventilation with high positive end-expiratory pressure and the use of the neuromuscular blocking agent cisatracurium for 48 hours was suggested for patients with ARDS with ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF) ratios less than or equal to 27 and 20 kPa, respectively. Extracorporeal membrane oxygenation was suggested as an adjunct to protective mechanical ventilation for patients with very severe ARDS. In the absence of adequate evidence, research recommendations were made for the use of corticosteroids and extracorporeal carbon dioxide removal.