Diaphragmatic Electromyography Analysis During Two Different Mechanical Ventilation Techniques in Patients with Neuromuscular Diseases

Abstract-The aim of the present study is to analyse changes in the diaphragmatic electromyography integral, as a direct expression of the patients inspiratory effort and index of neural respiratory drive, and parameters associated with ventilatory function in patients with prolonged weaning under Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatoy Assist (NAVA). Five patients affected by neuromuscular diseases were recruited. Each patient underwent a sequence of decreasing inspiratory support levels under NAVA and PSV, randomly assigned, from a baseline to a final level. At baseline, the value of diaphragmatic electromyography integral was higher under NAVA compared to PSV and increased in both ventilation modes progressing to final level. Higher values of inspiratory time and neural inspiratory time were observed in PSV at final level compared to baseline level. Conversely, a significant decrease of neural inspiratory time from baseline level to final level was observed in NAVA. Tidal volume at final level was significantly lower than at baseline level in both ventilation modes. These preliminary results show that in prolonged weaning patients affected by neuromuscular disease NAVA ventilation is associated to a higher diaphragmatic electromyography activity compared to PSV with same level of ventilation and subjective comfort

Holistic management of patients with progressive pulmonary fibrosis

Progressive pulmonary fibrosis (PF) is a complex interstitial lung disease that impacts substantially on patients’ daily lives, requiring personalised and integrated care. We summarise the main needs of patients with PF and their caregivers, and suggest a supportive care approach. Individualised care, education, emotional and psychological support, specialised treatments, and better access to information and resources are necessary. Management should start at diagnosis, be tailored to the patient’s needs, and consider end-of-life care. Pharmacological and non-pharmacological interventions should be individualised, including oxygen therapy and pulmonary rehabilitation, with digital healthcare utilised as appropriate. Further research is needed to address technical issues related to oxygen delivery and digital healthcare.</p

8th International conference on management and rehabilitation of chronic respiratory failure: the long summaries – part 2

This paper summarizes the Part 2 of the proceedings of the 8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure, held in Pescara, Italy, on 7 and 8 May, 2015. It summarizes the contributions from numerous experts in the field of chronic respiratory disease and chronic respiratory failure. The outline follows the temporal sequence of presentations. This paper (Part 2) includes sections regarding: Promoting Physical Activity across the Spectrum of COPD (Physical activity: definitions, measurements, and significance; Increasing Physical Activity through Pharmacotherapy in COPD); Pulmonary Rehabilitation in Critical Illness (Complex COPD with comorbidities and its impact during acute exacerbation; Collaborative Self-Management in COPD: A Double-Edged Sword?; and Pulmonary Rehabilitation in Critical Illness

Integrating the care of the complex COPD patient

The European Seminars in Respiratory Medicine has represented an outstanding series updating new science in respiratory disease from the 1990\u2019s up to the early beginning of this 21st century [1,2]. Its aim is to update issues and current science, focusing on the multidisciplinary approach to patients with respiratory disease. As such, it represents a unique opportunity for specialists in Respiratory Medicine involved in Basic and Clinical Research to discuss topical and debated problems in medical care, at a top level forum guided by an expert panel of authors. The structure of the seminar is based on the following pillars: \u2022 Attendance at the Seminars is strictly limited: selection of participants is based, in order of priority, on scientific curriculum, age (younger specialists are privileged), and early receipt of the application form. \u2022 Each topic is allotted considerable time for presentation and discussion. The first section is devoted to a series of presentations (with adequate time allocated for discussion) by an expert panel of researchers and clinicians. In the second section involves discussions of controversial issues, in a smaller audience format encouraging interaction between the panel and audience. \u2022 \u201cMeet the expert\u201d seminars discuss topical subjects in more depth, utilizing an interactive tutorial

Tele-assistance in pulmonary diseases: current status and open issues

Tele-assistance represents a fundamental medical application of advanced technologies. Evidence suggests that this technology when applied to monitoring and treatment may provide specific benefits to patients with respiratory diseases and their relatives. Economic advantages for healthcare systems, though potentially high, are still poorly investigated

A proposal of a new model for long-term weaning: Respiratory intensive care unit and weaning center

SummaryBackgroundRespiratory intermediate care units (RICU) are hospital locations to treat acute and acute on chronic respiratory failure. Dedicated weaning centers (WC) are facilities for long-term weaning.AimWe propose and describe the initial results of a long-term weaning model consisting of sequential activity of a RICU and a WC.MethodsWe retrospectively analysed characteristics and outcome of tracheostomised difficult-to wean patients admitted to a RICU and, when necessary, to a dedicated WC along a 18-month period.ResultsSince February 2008 to November 2009, 49 tracheostomised difficult-to wean patients were transferred from ICUs to a University-Hospital RICU after a mean ICU length of stay (LOS) of 32.6 ± 26.6 days. The weaning success rate in RICU was 67.3% with a mean LOS of 16.6 ± 10.9 days. Five patients (10.2%) died either in the RICU or after being transferred to ICU, 10 (20.4%) failed weaning and were transferred to a dedicated WC where 6 of them (60%) were weaned. One of these patients was discharged from WC needing invasive mechanical ventilation for less than 12h, 2 died in the WC, 1 was transferred to a ICU. The overall weaning success rate of the model was 79.6%, with 16.3% and 4.8% in-hospital and 3-month mortality respectively. The model resulted in an overall 39 845 ± 22 578 € mean cost saving per patient compared to ICU.ConclusionThe sequential activity of a RICU and a WC resulted in additive weaning success rate of difficult-to wean patients. The cost-benefit ratio of the program warrants prospective investigations