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Introduction: TBM can be treated by noninvasive positive airway stenting with the use of portable continuous positive airway pressure (CPAP) devices. CPAP improves exercise tolerance. However, the level of EPAP can be challenging to determine. Our aim was to determine if the level of EPAP required to stent the trachea was correlated to the improvement in exercise capacity. Methods: We retrospectively reviewed the recordings of bronchoscopy performed for the clinical management of patients with TBM referred for CPAP initiation. During the bronchoscopy, the EPAP level was titrated by 5cmH2O increments from 5cmH2O to 20cmH2O. We measured: the decrease in lumen area (DLA) from inspiration to expiration, the angulation α between the posterior and the lateral wall during expiration as well as the anteroposterior distance (apD). These measurements were made during tidal breathing. They were compared to the improvement in the 6-minute walking distance (6MWD) achieved with CPAP. Results: Our cohort consisted of 16 patients. The use of portable CPAP improved by 33m [11 – 53] when compared to self-ventilation (p=0.01). At 5cmH2O, the EPAP did not change the DLA nor the α angle or the apD. At 10cmH2O and above a significant improvement was seen in all these parameters (p Conclusion: Our results suggest that a significant level of EPAP is required to improve the exercise capacity of patients with TBM.

Introduction: TBM is defined by a 50% reduction of the trachea lumen during expiration. However, no data supports this threshold and it may not reflect exercise limitation. The aim of our study was to assess whether endoscopic morphometric parameters could predict exercise limitation in these patients. Methods: We reviewed all the endoscopic recordings of patients referred in our center for the clinical management of TBM between January 2017 and January 2019. For each patient, we measured: the decrease in lumen area (DLA) from inspiration to expiration, the angulation α between the posterior and the lateral wall during expiration as well as the anteroposterior distance (apD). These measurements were made during tidal breathing (TB) and during forced vital capacity maneuvers (FVC). These measurements were compared to the 6-minute walking distance (6MWD) whilst self-venting. Results: We included 16 patients. The DLA was 24±8% during TB and 38±10% during FVC (p Conclusion: The 50% expiratory collapse commonly used to diagnose TBM is poorly correlated to exercise limitation. Airway collapse during TB is correlated to the 6MWD and therefore may be a more relevant marker of the burden of the disease.

Introduction: EDAC is a rare condition for which treatment options are sparse. Pneumatic airway stenting using CPAP is a non invasive treatment approach. Using portable CPAP devices with built-in battery during exercise may help to improve breathlessness in patients with EDAC. The aim of our study was to assess the improvement in exercise capacity in patients with EDAC. Methods: Retrospective monocentric study including patients referred for suspicion of EDAC between 01/2017 and 02/2019 that underwent bronchoscopy that confirmed EDAC. Results: Out of the 30 patients referred, 27 had EDAC. Patients had a mean age of 65±11 with a BMI of 28±6kg/m2. EDAC was idiopathic in 4 patients and secondary to COPD (n:10), obesity (n:8), asthma (n:4) and lung transplantation (n:1). At rest, mMRC dyspnea scale was 3.2±1.0. Health-related quality of life assessed by the severe respiratory insufficiency questionnaire was low: 46±17. Daytime arterial blood gases were: pH: 7.42±0.06, PaCO2: 5.4±1.4kPa, PaO2: 11.0±4.0kPa. Lung function tests results were: FEV1:1.5±0.7L (63±34%), FVC: 2.3±0.7L (77±27%), FEV1/FVC:69±23%. Tracheal lumen reduction was estimated at 36±23% at rest. Level of positive expiratory pressure requires to counterbalance expiratory collapse was 13±4cmH2O. Distance achieved on the 6 minute-walking test (6MWT) on room air was 280m [158 – 346] (52±27%). Distance improved significantly with CPAP: +32m [8 – 53] (p:0.003). Dyspnea (Borg scale) at the end of 6MWT did not improve significantly: -1.5 [-2 – 3] (p:0.405). Conclusion: Portable CPAP improves exercise capacity in patients with EDAC and may enhance benefits of pulmonary rehabilitation in those patients.

Aims: Mechanical ventilation (MV) is an usual care inintensive care units (ICU) to treat acute respiratory failure but has for adverse event an alteration of diaphragmatic structure and function. Diaphragmatic dysfunction is characterized by respiratory muscles weakness and prolonged duration of mechanical ventilation. Inspiratory Muscle Training (IMT) improves diaphragmatic strength. It is recommended by ERS/ESICM statement, feasible, safe and can facilitate ventilator weaning. We sought to describe care practices regarding IMT in french ICU. Material and Method: We provided a phone survey questionnaire in all the 294 ICUs identified in France. Results: 246 responded (83.7%).Therapists stated that they used IMT were 38.2% [95% CI, 32.4 to 44.4]. They used IMT in patients who failed to wean off from MV (35.1% [95% CI, 26.2 to 45.2]) and significantly more in non-sedated patients (p Conclusion: IMT is slightly used in french ICU despite recommendations and results from clinical studies. Most of practices are not evidence-based. Developing strategies is required to implement evidence based techniques to wean off from MV.