Respirology : official journal of the Asian Pacific Society of Respirology
-
Oxygen is used in many clinical scenarios, however the variable performance of nasal cannulae makes determining the precise fraction of inspired oxygen (FiO2 ) difficult. We developed a novel method for measurement of the tracheal FiO2 using a catheter placed via bronchoscopy. We investigate the effects of oxygen delivery, respiratory rate, mouth position and estimated minute ventilation (VE ) on the FiO2 delivered by nasal cannulae. ⋯ Continuous measurement of the FiO2 using a transtracheal catheter provides detailed insight into inspiratory changes of the FiO2 delivered by nasal cannulae. Our study confirms that respiratory rate, VE and mouth position significantly influence the inspired oxygen concentration. These parameters should be accounted for when prescribing oxygen.
-
Multicenter Study Comparative Study
Diagnostic performance comparison of the Chartis System and high-resolution computerized tomography fissure analysis for planning endoscopic lung volume reduction.
Endobronchial valve (EBV) therapy is optimized in patients who demonstrate little or no collateral ventilation (CV). The accuracy of the Chartis System and visual assessment of high-resolution computerized tomography (HRCT) fissure completeness by a core radiology laboratory for classifying CV status was compared by evaluating the relationship of each method with target lobe volume reduction (TLVR) after EBV placement. ⋯ When evaluating patients for likelihood of successful EBV therapy, the Chartis System CV assessment and HRCT fissure analysis appear to have comparable accuracy. Both techniques were found to be beneficial for EBV procedure planning.
-
Exercise-induced bronchoconstriction (EIB) is the temporary narrowing of the airways caused by physical exercise. Its exact pathophysiology is unclear; however, acute changes in airways pH may play a role. Exhaled breath condensate (EBC) pH was suggested as a surrogate indicator for airway acid-base status, but its value is also affected by volatile molecules and respiratory droplet dilution. The aim of the study was to assess changes in EBC pH during EIB. ⋯ The development of EIB was related to acute changes of EBC pH, which suggest the role of airway pH decrease in the pathophysiology of EIB. Exercise-induced changes in exhaled biomarkers suggest methodological precautions to avoid physical exercise before performing exhaled breath tests.
-
Randomized Controlled Trial
Randomized trial of 'intelligent' autotitrating ventilation versus standard pressure support non-invasive ventilation: impact on adherence and physiological outcomes.
Effective non-invasive ventilation (NIV) therapy is dependent on optimal ventilator settings to maximize clinical benefit and patient tolerance. Intelligent volume-assured pressure support (iVAPS) is a hybrid mode of servoventilation, providing constant automatic adjustment of pressure support (PS) to achieve a target ventilation determined by the patient's requirements. In a randomized crossover trial, we tested the hypothesis that iVAPS, with automated selection of ventilator settings, was non-inferior to standard PS ventilation, with settings determined by an experienced health-care professional, for controlling nocturnal hypoventilation in patients naive to NIV. ⋯ iVAPS servoventilation with automation of ventilation settings is as effective as PS ventilation initiated by a skilled health-care professional in controlling nocturnal hypoventilation and produced better overnight adherence in patients naive to NIV.
-
Bronchoscopy education is undergoing significant changes in step with other medical and surgical specialties that seek to incorporate simulation-based training and objective measurement of procedural skills into training programmes. Low- and high-fidelity simulators are now available and allow learners to gain fundamental bronchoscopy skills in a zero-risk environment. ⋯ Educational concepts including the 'flipped classroom' model and problem-based learning exercises are increasingly used in bronchoscopy training programmes. These learner-centric teaching modalities require well-trained educators, which is possible thorough the expansion of existing faculty development programmes.