Case for continuing community NIV and CPAP during the COVID-19 epidemic

Dear Editor, Recent clinical guidelines regarding the use of home non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) during the COVID-19 epidemic have tried to balance the risks of stopping NIV or CPAP against the unknown potential risk of increased aerosol-related transmission to family and carers. We read with interest views put forward by Barker et al but feel that wider aspects need consideration, and for NIV and CPAP separately

Assessing the impact of posture on diaphragm morphology and function using an open upright MRI system – a pilot study

PurposeThe diaphragm is the most important muscle of respiration. Disorders of the diaphragm can have a deleterious impact on respiratory function. We aimed to evaluate the use of an open-configuration upright low-field MRI system to assess diaphragm morphology and function in patients with bilateral diaphragm weakness (BDW) and chronic obstructive pulmonary disease (COPD) with hyperinflation.MethodThe study was approved by the National Research Ethics Committee, and written consent was obtained. We recruited 20 healthy adult volunteers, six subjects with BDW, and five subjects with COPD with hyperinflation. We measured their vital capacity in the upright and supine position, after which they were scanned on the 0.5 T MRI system during 10-second breath-holds at end-expiration and end-inspiration in both positions. We developed and applied image analysis methods to measure the volume under the dome, maximum excursion of hemidiaphragms, and anterior-posterior and left-right extension of the diaphragm.ResultsAll participants were able to complete the scanning protocol. The patients found scanning in the upright position more comfortable than the supine position. All differences in the supine inspiratory-expiratory parameters, excluding left-right extension, were significantly smaller in the BDW and COPD groups compared with healthy volunteers. No significant correlation was found between the postural change in diaphragm morphology and vital capacity in either group.ConclusionOur combined upright-supine MR imaging approach facilitates the assessment of the impact of posture on diaphragm morphology and function in patients with BDW and those with COPD with hyperinflation

non invasive ventilation during surgery under neuraxial anaesthesia a pathophysiological perspective on application and benefits and a systematic literature review

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British Thoracic Society/Intensive Care Society Guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

The British Thoracic Society (BTS) published the guideline ‘The use of non-invasive ventilation in acute respiratory failure’ in 2002.1 This was in response to trials that had demonstrated that non-invasive ventilation (NIV) was an alternative to invasive mechanical ventilation (IMV) in life-threatening respiratory acidosis due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). It drew attention to evidence that, when NIV was used in the less severely unwell patient, it also limited progression to more severe respiratory failure.2 The trial also demonstrated the feasibility, of delivering NIV on general medical or admission wards that had enhanced support and when staff were provided with ongoing training