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Summary: Background: The level at which arterial carbon dioxide tension (PaCO2) a few months after introduction of long-term non-invasive positive pressure ventilation (NPPV) is associated with a favorable prognosis remains uncertain. Methods: Data on 184 post-tuberculosis patients with chronic restrictive ventilatory failure who were receiving long-term domiciliary NPPV were examined retrospectively. Average PaCO2 3–6 months after NPPV (3- to 6-mo PaCO2) and potential confounders were analyzed with discontinuation of long-term NPPV as the primary outcome. The effects of 3- to 6-mo PaCO2 on annual hospitalization rates due to respiratory deterioration from 1 year before to 3 years after the initiation of NPPV were examined. The effect of the difference between the PaCO2 value at the start of NPPV (0-mo PaCO2) and the PaCO2 value 3- to 6-mo later (d-PaCO2) on continuation rates for NPPV was also assessed in patients who initiated NPPV while in a chronic state. Results: Patients with relatively low 3- to 6-mo PaCO2 values maintained a relatively low PaCO2 6–36 months after NPPV (p < 0.0001) and had significantly better continuation rates (p < 0.03) and lower hospitalization rates from the 1st to 3rd year of NPPV (p = 0.008, 0.049, 0.009, respectively) than those with higher levels. The 0-mo PaCO2 (p = 0.26) or d-PaCO2 (p = 0.86) had no predictive value. Conclusion: A relatively low 3- to 6-mo PaCO2 value was predictive of long-term use of NPPV. The target values for 3- to 6-mo PaCO2 may, therefore, be less than 60 mmHg in post-tuberculosis patients, although more studies are needed. [Copyright &y& Elsevier]

Objective Obstructive Sleep Apnea Syndrome (OSAS) causes multiple breathing interruptions during sleep and increases mortality if left untreated. Continuous positive airway pressure (CPAP) therapy improves the prognosis of OSAS; however, patient adherence is often poor. This study investigated the relationship between monthly hospital visits and CPAP adherence to CPAP therapy in patients with OSAS. Methods We studied 119 patients (93 men and 26 women) at the Minami Kyoto Hospital between June 2022 and May 2023. CPAP adherence was measured daily. Hospital/clinic visits were categorized as "Last minute visits at the end of the month" (≥25th of the month) and analyzed in relation to CPAP adherence. Results The average duration of CPAP use duration were 5 h, 47 min, and 43 s. Patients visiting on or after the 25th of month had significantly lower CPAP use (4 h, 17 min, 05 s) compared to those visiting before the 25th of month (6 h, 01 min, 47 s, p=0.003). No significant correlation was found between the visit frequency and adherence to CPAP therapy, with a lower visit frequency unexpectedly corresponding to longer CPAP use (p=0.04). Conclusion The timing of monthly clinic visits significantly affected CPAP adherence, with late-month visits associated with poorer adherence. Visit frequency showed no clear correlation with adherence, suggesting that other factors may have influenced CPAP use. Further supportive interventions can enhance adherence and improve the treatment outcomes.

Objective The effects of partial pressure of arterial oxygen (PaO 2 ) after introducing long-term noninvasive ventilation (NIV) on the prognosis of patients with restrictive thoracic disease and chronic respiratory failure are not exactly known. Methods Data from 141 patients with restrictive thoracic disease under long-term nocturnal NIV were retrospectively examined. We divided the patients into 2 groups according to the daytime PaO 2 value while breathing spontaneously with prescribed oxygen at 12 months after introducing NIV: PaO 2 ≥80 Torr group (n=76) and PaO 2 <80 Torr group (n=65). Results During the 4-year follow-up, the mortality was significantly higher in the PaO 2 <80 Torr group than in the PaO 2 ≥80 Torr group (50.8% vs. 32.9%, p=0.03). Independent factors associated with the 4-year mortality after introducing NIV determined by a multivariate logistic regression analysis were a low body mass index [odds ratio (OR) 0.87; 95% confidence interval (CI) 0.77 to 0.97; p=0.01], assisted mode with NIV (OR 4.11; 95% CI, 1.79 to 9.45; p=0.0009), hospitalization during the first year of introducing NIV (OR 1.72; 95% CI, 1.06 to 2.79; p=0.03), and daytime PaO 2 <80 Torr at 12 months after introducing NIV (OR 2.30; 95% CI, 1.03 to 5.10; p=0.04). Conclusion A low daytime PaO 2 at 12 months after introducing NIV was an independent risk factor for mortality. Keeping the daytime PaO 2 ≥80 Torr through the adjustment of the nocturnal NIV settings or increased diurnal supplemental oxygen may help improve the prognosis in patients with restrictive thoracic disease who are under NIV.

Background: The significance of changes in P(aCO2) during long-term noninvasive ventilation (NIV) on prognosis remains unclear. We aimed to clarify whether stabilizing P(aCO2) during NIV had a favorable prognostic effect., Methods: Data from 190 subjects with restrictive thoracic disease and who received long-term NIV were studied retrospectively. The annual change in P(aCO2) during NIV was determined using a simple linear regression method for each subject who had at least 4 6-month intervals of P(aCO2) data. Annual changes in P(aCO2) during long-term NIV and possible confounders were analyzed with discontinuation of long-term NIV as the main outcome., Results: One hundred and twenty-five subjects who had > 4 6-month intervals of P(aCO2) data were included in the study. P(aCO2) during long-term NIV decreased in 41 subjects (group 1; < 0 mm Hg/y), increased slightly in 42 subjects (group 2; between 0 and 1.85 mm Hg/y), and increased significantly in 42 subjects (group 3; > 1.85 mm Hg/y). Smaller annual changes in P(aCO2) (P < .001) and a control ventilator mode (P = .008) were associated with a significantly higher probability of continuing NIV, compared with decreased P(aCO2) 3-6 months after the start of long-term NIV (P = .11). The 10-y probability of continuing NIV was 69% in group 1, 39% in group 2, and 12% in group 3., Conclusions: A decrease in the annual change of P(aCO2) during long-term NIV was shown to be a significantly prognostically favorable factor. Efforts to reduce P(aCO2) should be made if P(aCO2) increases at a greater rate during long-term NIV., (Copyright © 2014 by Daedalus Enterprises.)