Quelles mesures non médicamenteuses associées ?

Un intérêt de la kinésithérapie respiratoire en termes de désencombrement bronchique était mentionné dans les recommandations de 2003 (Tableau 1). Cet intérêt doit être nuancé et, sur base des conclusions d’une revue systématique, ne semble justifié que pour des patients présentant un encombrement important [1] (niveau de preuve A). Cependant, plus de 10 ans après ces recommandations, le message reste globalement identique. En effet, il faut reconnaître que le niveau de preuve reste peu élevé. Ainsi, une étude portant sur une technique d’expiration lente (ELTGOL) n’a pas montré de bénéfice chez des patients BPCO que ce soit à la sortie de l’hospitalisation ou après 6 mois à l’exception d’une tendance à la réduction des exacerbations ou hospitalisations pendant les 6 mois de suivi [2] (niveau de preuve A). La présence de bronchiectasies, la quantité de sécrétions produites, le degré d’obstruction et une diminution de la pression de rétraction élastique du poumon devraient être pris en compte dans la décision de recourir aux manoeuvres de désencombrement dont le choix dépendra de leur effet physiologique (compression dynamique des voies aériennes et flux expiratoire) [...

Detection of COPD exacerbations with continuous monitoring of breathing rate and inspiratory amplitude under oxygen therapy

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is one of the main causes of morbidity and mortality worldwide. Its management represents real economic and public health burdens, accentuated by periods of acute disease deterioration, called exacerbations. Some researchers have studied the interest of monitoring patients’ breathing rate as an indicator of exacerbation, although achieving limited sensitivity and/or specificity. In this study, we look to improve the previously described method, by combining breathing variables, using multiple daily measures, and using an artificial intelligence-based novelty detection approach. Methods Patients with COPD were monitored with a telemedicine device during their stay in a rehabilitation care center. Daily measures are compared to individually trained reference models based on: i. oxygen therapy duration ii. mean breathing rate, iii. mean inspiratory amplitude, iv. mean breathing rate and mean inspiratory amplitude, v. average distribution of breathing rate and inspiratory amplitude, vi. hidden Markov model (HMM) from a time series of breathing rate and inspiratory amplitude. Results A set of 16 recordings with exacerbation and 23 recordings without exacerbation was obtained. When using a daily measure of breathing rate, pre-exacerbation periods were identified with a specificity of 50% and a sensitivity of 55.6%. The method based on daily oxygen therapy usage and the method based on time series obtain a sensitivity of 76.8% and 73.2%, respectively, for a fixed specificity of 50%. Conclusion A single daily measure of breathing rate alone is not sufficient for the detection of pre-exacerbation periods. More complete models also achieve limited performance, equivalent to models based on changes in the duration of therapy usage

Medical hypnosis increases 6-min walking test distance in severe COPD patients: a case–control study

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Ventilator integrated polygraphy for patients using non-invasive ventilation; Case report

The COVID-19 pandemic has meant that home respiratory services have needed to be reviewed. As a result, new solutions have been developed and implemented. The Vivo 45 (TM) (Breas, Molnlycke, Sweden) is a ventilator that offers clinicians the ability to attach effort belts to the device. This allows the clinician to review ventilator traces with the addition of thoracic and abdominal activity. This allows more flexibility for the monitoring of patients at home and in the hospital, with detection of patient ventilator asynchrony (PVA). Decreasing PVA may improve ventilator adherence and increased ventilator usage improves survival. We report three cases of patients undergoing overnight monitoring with the Vivo 45 (TM), highlighting the benefit of ventilator integrated polygraphy. In our three cases we demonstrate a simple safe tool to optimize NIV treatment over one or two-night recordings using ventilator downloaded software with the addition of effort belts and pulse oximetry without involving more than one machine and without hospitalization in a sleep unit

Temporal expectations guide dynamic prioritization in visual working memory through attenuated α oscillations

Although working memory is generally considered a highly dynamic mnemonic store, popular laboratory tasks used to understand its psychological and neural mechanisms (such as change detection and continuous reproduction) often remain relatively "static," involving the retention of a set number of items throughout a shared delay interval. In the current study, we investigated visual working memory in a more dynamic setting, and assessed the following: (1) whether internally guided temporal expectations can dynamically and reversibly prioritize individual mnemonic items at specific times at which they are deemed most relevant; and (2) the neural substrates that support such dynamic prioritization. Participants encoded two differently colored oriented bars into visual working memory to retrieve the orientation of one bar with a precision judgment when subsequently probed. To test for the flexible temporal control to access and retrieve remembered items, we manipulated the probability for each of the two bars to be probed over time, and recorded EEG in healthy human volunteers. Temporal expectations had a profound influence on working memory performance, leading to faster access times as well as more accurate orientation reproductions for items that were probed at expected times. Furthermore, this dynamic prioritization was associated with the temporally specific attenuation of contralateral α (8-14 Hz) oscillations that, moreover, predicted working memory access times on a trial-by-trial basis. We conclude that attentional prioritization in working memory can be dynamically steered by internally guided temporal expectations, and is supported by the attenuation of α oscillations in task-relevant sensory brain areas. SIGNIFICANCE STATEMENT: In dynamic, everyday-like, environments, flexible goal-directed behavior requires that mental representations that are kept in an active (working memory) store are dynamic, too. We investigated working memory in a more dynamic setting than is conventional, and demonstrate that expectations about when mnemonic items are most relevant can dynamically and reversibly prioritize these items in time. Moreover, we uncover a neural substrate of such dynamic prioritization in contralateral visual brain areas and show that this substrate predicts working memory retrieval times on a trial-by-trial basis. This places the experimental study of working memory, and its neuronal underpinnings, in a more dynamic and ecologically valid context, and provides new insights into the neural implementation of attentional prioritization within working memory

Validation of respiratory rate measurements from remote monitoring device in COPD patients

International audienceWith healthcare objectives and budget constraint, remote monitoring of chronic obstructive pulmonary disease (COPD) patients is an important challenge in most European countries. Recent works have shown that it is possible to predict COPD exacerbation based on monitoring of simple parameters, such as the respiratory rate (RR) of the patient in spontaneous ventilation or under non-invasive ventilation. Until now, these devices do not allow a daily automatic data remote transmission,[4] or it is restricted to patients under mechanical ventilation. TeleOx® (SRETT, Boulogne-Billancourt, France), the first oxygen flow rate remote monitoring device, also allows a RR measurement by associating a pressure sensor and a fluidic oscillator flow sensor. A median RR is output every 5 minutes based on time interval between two consecutive respiratory cycles.In this study, we compared the corresponding RR measurements between TeleOx® and the reference polygraph (Nox-T3®, Nox Medical Inc. Reykjavik, Iceland) from COPD patients under nasal oxygen therapy with flow rates between 0.5 and 5.0 litres per minute. Patients without mechanical ventilation and without any other respiratory pathology were eligible to the study if they would undergo a ventilatory polygraph record for other reason