Clinical use of Heliox in Asthma and COPD

Heliox is a low density gas mixture of helium and oxygen commonly used in deep diving (> 6 ATM). This mixture has been also used for clinical purposes, particularly in the critical care setting. Due to of its physical proprieties, Heliox breathing reduces air flow resistances within the bronchial tree; in patients with obstructive lung diseases Heliox may also reduce the work of breathing and improve pulmonary gas exchange efficiency. Beneficial effects have been documented in severe asthma attacks and in patients with chronic obstructive pulmonary disease. A reduction in WOB during mechanical ventilation and an increase in exercise endurance capacity have also been described in COPD. Heliox has been also used in the treatment of upper airways obstruction, bronchiolitis and bronchopulmonary dysplasia. Despite the encouraging results, Heliox use in routine practice remains controversial because of technical implications and high costs

Exercise respiratory cycle time components in patients with emphysema

Background: We have recently demonstrated that in patients with COPD the severity of emphysema (E) measured by high resolution computed tomography (HRCT) correlated with: ratio VTpeak/FEV1; VE/VCO2 slope and PETCO2 values at peak exercise. The aim of this study was to further investigate if exercise respiratory cycle time components correlated with % of E measured by HRCT. Method: Twelve patients (age = 65±8 yrs; FEV1 = 55±17%pred) with moderate to severe E (quantified by lung HRCT as % voxels < −910 HU) were evaluated with incremental cardiopulmonary exercise testing (CPET). Mean inspiratory time (TiM), mean total respiratory cycle time (TtotM), mean expiratory time during exercise (TeM) and mean expiratory time during the last third of exercise (TeM-end), has been calculated. Results: Both TeM and TeM-end had a good linear correlation with % of E (r = 0,61; p = 0,004 and r = 0,63; p = 0,003). Moreover, by dividing the patients in two groups based on the % of E (>50% and <50%), we observed that patients with higher % of E had longer TeM (TeM: 1,72±0,26sec vs 1,34±0,27sec, p = 0,005) and TeM-end. A good linear correlation has been observed also between TeM and PETCO2 and VE/VCO2 (r = 0,64; p = 0,002 and r = 0,7; p = 0,0005). TeM did not correlated with resting lung function values or inspiratory capacity (IC). Conclusion: The data confirm that distinct physiologic response pattern can be detected at CPET in these patients

Cardiopulmonary exercise testing in the functional and prognostic evaluation of patients with pulmonary diseases

Exercise testing is increasingly utilized to evaluate the level of exercise intolerance in patients with lung and heart diseases. Cardiopulmonary exercise testing (CPET) is considered the gold standard to study a patient's level of exercise limitation and its causes. The 2 CPET protocols most frequently used in the clinical setting are the maximal incremental and the constant work rate tests. The aim of this review is to focus on the main respiratory diseases for which exercise tolerance is indicated; for example, chronic obstructive pulmonary disease, interstitial lung disease, primary pulmonary hypertension and cystic fibrosis. This review also focuses on the variables/indices that are utilized in the functional and prognostic evaluation. The recognition of abnormal response patterns of ventilatory, cardiac and metabolic limitation to exercise may help in the diagnostic evaluation. In addition, CPET indexes can provide important functional and prognostic information regarding patients with pulmonary disease. Exercise indices, such as peak oxygen uptake (V'O 2 peak), ventilatory equivalents for carbon dioxide production (V'E-/V'CO2) and arterial oxygen saturation (S pO2), have in fact proven to be better predictors of prognosis than lung function measurements obtained at rest. Moreover, useful information on the effects of therapeutic interventions may be obtained by CPET by studying the changes in endurance capacity during high-intensity constant work rate protocols. Copyright © 2009 S. Karger AG

Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

Background: Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods: In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range. Results: Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and d-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and d-dimer (B = 0.419, p = 0.001; B = −&nbsp;0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p &lt; 0.001; and B = 0.253, p = 0.001, respectively). Conclusions: Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting