Change in pulmonary mechanics and the effect on breathing pattern of high flow oxygen therapy in stable hypercapnic Chronic Obstructive Pulmonary Disease

Chronic hypercapnic respiratory failure (CHF) represents a major issue in stable chronic obstructive pulmonary disease (COPD). Non-invasive Ventilation (NIV) improves pulmonary gas exchange function with decrease in PaCO2 and rise in pH. Long-term NIV reduces mortality in these patients and time to first exacerbations, but adherence to ventilatory therapy is poor. High Flow Oxygen Therapy (HFOT) could counterbalance the effect of intrinsic Positive End Expiratory Pressure (PEEPi) and optimize Ventilation/Perfusion ratio through the modification of breathing pattern; then, HFOT could be an appealing alternative to home NIV. Therefore, in order to assess HFOT effects on respiratory work of breathing, compared to NIV as gold standard, we studied the consequences of these two form of non-invasive respiratory support on: inspiratory effort, as assessed by measuring transdiaphragmatic pressure; breathing pattern; gas exchange. Fourteen patients with hypercapnic stable COPD underwent five 30-min trials, in a random order: HFOT at two flow rates (20 L/min and 30 L/min), both with open and closed mouth, and NIV. After each trial, standard oxygen therapy was reinstituted for ten min. Compared with baseline, HFOT and NIV significantly improved breathing pattern, although to different extents, and reduced inspiratory effort; however, arterial carbon dioxide oxygen tension decreased but not significantly. These results indicate a possible role for HFOT in the long-term management of patients with hypercapnic stable COPD, because of no rise in PaCO2, and improved respiratory mechanic

Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers

BACKGROUND: A few studies have assessed the short-term effects of low-dose nicotine e-cigarettes, while data about nicotine-free e-cigarettes (NF e-cigarettes) are scanty. Concerns have been expressed about the use of NF e-cigarettes, because of the high concentrations of propylene glycol and other compounds in the e-cigarette vapor. METHODS: This laboratory-based study was aimed to compare the effects of ad libitum use of a NF e-cigarette or and a traditional cigarette for 5 min in healthy adult smokers (n\u2009=\u200910) and non-smokers (n\u2009=\u200910). The main outcome measures were pulmonary function tests, fraction of exhaled nitric oxide (FeNO) and fractional concentration of carbon monoxide (FeCO) in exhaled breath. RESULTS: The traditional cigarette induced statistically significant increases in FeCO in both smokers and non-smokers, while no significant changes were observed in FeNO. In non-smokers, the traditional cigarette induced a significant decrease from baseline in FEF75 (81 %\u2009\ub1\u200935 % vs 70.2 %\u2009\ub1\u200928.2 %, P\u2009=\u20090.013), while in smokers significant decreases were observed in FEF25 (101.3 %\u2009\ub1\u200916.4 % vs 93.5 %\u2009\ub1\u200931.7 %, P\u2009=\u20090.037), FEV1 (102.2 %\u2009\ub1\u20099.5 % vs 98.3 %\u2009\ub1\u200910 %, P\u2009=\u20090.037) and PEF (109.5 %\u2009\ub1\u200914.6 % vs 99.2 %\u2009\ub1\u200917.5 %, P\u2009=\u20090.009). In contrast, the only statistically significant effects induced by the NF e-cigarette in smokers were reductions in FEV1 (102.2 %\u2009\ub1\u20099.5 % vs 99.5\u2009\ub1\u20097.6 %, P\u2009=\u20090.041) and FEF25 (103.4 %\u2009\ub1\u200916.4 % vs 94.2 %\u2009\ub1\u200916.2 %, P\u2009=\u20090.014). DISCUSSION: The present study demonstrated that the specific brand of NF e-cigarette utilized did not induce any majoracute effects. In contrast, several studies have shown that both traditional cigarettes and nicotine-containing e-cigarettes have acute effects on lung function. Our study expands on previous observations on the effects of NF e-cigarettes, but also for the first time describes the changes induced by smoking one traditional cigarette in a group of never smokers. CONCLUSIONS: The short-term use of the specific brand of NF e-cigarette assessed in this study had no immediate adverse effects on non-smokers and only small effects on FEV1 and FEF25 in smokers. The long-term health effects of NF e-cigarette use are unknown but worthy of further investigations. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02102191

Diagnostic yield of rapid on-site evaluation transbronchial needle aspiration versus conventional transbronchial needle aspiration: a single center experience

Trans-bronchial needle aspiration allows lymph node sampling in several thoracic conditions; the ability of Rapid On-Site Evaluation (ROSE) to predict the final diagnosis in this setting has not been well characterized. We performed a retrospective study to establish the utility of ROSE in the diagnosis of thoracic diseases with mediastinal lymph node involvement. We retrospectively reviewed 297 patients with hilar-mediastinal lymph node enlargement detected at CT scan from January 2013 to April 2016. 201 patients underwent conventional TBNA; in 96 patients, TBNA procedure was performed by on-site presence of a team of pathologists and research morphologists. Lung neoplasms, sarcoidosis, infections and lymphoma were the most common diseases diagnosed with TBNA samples. TBNA simultaneously performed in combination with ROSE produced an increase in percentage of appropriate samples compared to single cTBNA (adequate samples cTBNA vs ROSE-TBNA: 73% vs 81%; p<0.05). Our observations indicate an increase in adequacy of fine needle aspirations and increased diagnostic yield in the ROSE group. In conclusions, ROSE may serve to reduce procedure time and enhance sample triaging therefore limiting the need for further invasive diagnostic testing

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

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Management of acute hypercapnic respiratory failure

Purpose of review The objective of this article is to review the most recent literature regarding the management of acute hypercapnic respiratory failure (AHRF). Recent findings In the field of AHRF management, noninvasive ventilation (NIV) has become the standard method of providing primary mechanical ventilator support. Recently, extracorporeal carbon dioxide removal (ECCO2R) devices have been proposed as new therapeutic option. Summary NIV is an effective strategy in specific settings and in selected population with AHRF. To date, evidence on ECCO2R is based only on case reports and case-control trials. Although the preliminary results using ECCO2R to decrease the rate of NIV failure and to wean hypercapnic patients from invasive ventilation are remarkable; further randomized studies ar

A case of haemoptysis and bilateral areas of lung consolidation sparing the right lower lobe

: Multiple primary lung cancers (MPLC) are often neglected. Obtaining pre-operative specimens through bronchoscopy could play a role. It is important to distinguish aerogenous metastasis from MPLC in the adenocarcinoma spectrum due to the different prognosis. https://bit.ly/3zbdVrw

Impact of long-term treatment with inhaled corticosteroids and bronchodilators on lung function in a patient with post-infectious bronchiolitis obliterans

Post-infectious bronchiolitis obliterans (PIBO) is a small airways disease characterized by fixed airflow limitation. Therefore, inhaled bronchodilators and corticosteroids are not recommended as maintenance therapy options. The management of PIBO currently consists only of close monitoring of affected patients, aimed at the prevention and early treatment of pulmonary infections. In recent years, there has been an increase in the incidence of PIBO in the pediatric population. Patients with PIBO are characterized by a progressive decline in lung function, accompanied by a decrease in overall functional capacity. Here, we report the case of a relatively young man diagnosed with PIBO and followed for three years. After short- and long-term therapy with an inhaled corticosteroid/ long-acting β2 agonist combination, together with an inhaled long-acting antimuscarinic, the patient showed relevant improvement of airway obstruction that had been irreversible at the time of the bronchodilator test. The lung function of the patient worsened when he interrupted the triple inhaled therapy. In addition, a 3-week pulmonary rehabilitation program markedly improved his physical performance