Spontaneous mode non-invasive ventilation fails to treat respiratory failure in a patient with Multi-mincore disease: a case report

The increased morbidity and mortality resulting from respiratory failure in patients with neuromuscular disorders and/or kyphoscoliosis can be reversed with non-invasive ventilation. Spontaneous mode bilevel pressure ventilation is preferred to other modes of ventilation, due to relative ease of use, but may not be suitable for all patients. We report a 27-year old woman with Multi-minicore disease whose respiratory failure was refractory to spontaneous mode bilevel pressure ventilation. When we altered settings and provided mandatory inspiratory rise time and respiratory rate, it augmented her respiratory efforts and improved ventilation. Our case report describes the benefit of individualising non-invasive ventilation in the management of respiratory failure due to neuromuscular weakness and kyphoscoliosis

Cardiorespiratory Phase-Coupling Is Reduced in Patients with Obstructive Sleep Apnea

Cardiac and respiratory rhythms reveal transient phases of phase-locking which were proposed to be an important aspect of cardiorespiratory interaction. The aim of this study was to quantify cardio-respiratory phase-locking in obstructive sleep apnea (OSA). We investigated overnight polysomnography data of 248 subjects with suspected OSA. Cardiorespiratory phase-coupling was computed from the R-R intervals of body surface ECG and respiratory rate, calculated from abdominal and thoracic sensors, using Hilbert transform. A significant reduction in phase-coupling was observed in patients with severe OSA compared to patients with no or mild OSA. Cardiorespiratory phase-coupling was also associated with sleep stages and was significantly reduced during rapid-eye-movement (REM) sleep compared to slow-wave (SW) sleep. There was, however, no effect of age and BMI on phase coupling. Our study suggests that the assessment of cardiorespiratory phase coupling may be used as an ECG based screening tool for determining the severity of OSA

Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: A qualitative study

BACKGROUND: Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low. AIMS: To identify barriers to, and facilitators for, referral to PR programmes from the perspective of Australian general practitioners. METHODS: Semi-structured interviews were conducted with general practitioners involved in the care of people with COPD. Interview questions were informed by a validated behavioural framework and asked about participants’ experience of referring people with COPD for PR, and barriers to, or facilitators of, this behaviour. Interviews were audiotaped, transcribed verbatim, and analysed using content analysis. RESULTS: Twelve general practitioners participated in this study, 10 of whom had never referred a patient to a PR programme. Four major categories relating to barriers to referral were identified: low knowledge of PR for COPD; low knowledge of how to refer; actual or anticipated access difficulties for patients; and questioning the need to do more to promote exercise behaviour change. Awareness of benefit was the only current facilitator. Three major categories of potential facilitators were identified: making PR part of standard COPD care through financial incentive; improving information flow with regard to referrals and services; and informing patients and public. CONCLUSIONS: Significant barriers to referral exist, but opportunities to change the organisation of practice and information management were identified. Behaviour change strategies which directly target these barriers and incorporate facilitators should make up the key components of interventions to improve referral to PR by general practitioners who care for people with COPD.

Frequency of referral to and attendance at a pulmonary rehabilitation program amongst patients admitted tro a tertiary hospital with chronic obstuctive pulmonary disease

Conclusions: PR had been implemented in a small proportion of patients admitted to hospital with an exacerbation of COPD due to gaps in both referral to and subsequent attendance at a programme. Strategies to improve referral to and participation in PR are required.

Illustration of the generation of synchrogram from the respiratory and ECG signals.

<p>a1, a2,…,a10 and b1, b2,….,b10 in the synchrogram plot represent the respiratory phases, based on the time points of R-peaks, for the first two and the following two respiratory cycles.</p

Group and sleep related comparison of RR interval and respiratory interval.

<p>The plus indicates that the differences in RR interval between the no/mild and severe OSA groups are significant (<i>p</i><0.0001). Similarly, the circle and hat indicates the significance (<i>p</i><0.0001) in RR interval or respiratory interval differences between moderate and severe or no/mild OSA groups respectively.</p

Percentage of coordination for different AHI groups and sleep stages using abdominal (ABDO) and thoracic (THOR) signals.

<p>Percentage of coordination for different AHI groups and sleep stages using abdominal (ABDO) and thoracic (THOR) signals.</p

Group and sleep related comparison of percentage of coordination (%cordn, mean ± SD) using original (upper panel) and surrogate data (lower panel) from abdominal signal.

<p>The plus indicates that the differences in %cordn between the no/mild and severe OSA groups are significant (<i>p</i><0.05). * (<i>p</i><0.01) and ** (<i>p</i><0.001) indicates the significant differences in %cordn between the SW and REM sleep stages and between the original and surrogate data respectively.</p