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Background: A high concentration of inspired supplemental oxygen may possibly cause hypercapnia and acidosis and increase mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Even so, patients with AECOPD are being treated with high oxygen flow rates when receiving inhalation drugs in the prehospital setting. A cluster-randomised controlled trial found that reduced oxygen delivery by titrated treatment reduced mortality—a result supported by observational studies—but the results have never been reproduced. In the STOP-COPD trial, we investigate the effect of titrated oxygen delivery compared with usual care consisting of high flow oxygen delivery in patients with AECOPD in the prehospital setting. Methods: In this randomised controlled trial, patients will be blinded to allocation. Patients with suspected AECOPD (n = 1888) attended by the emergency medical service (EMS) and aged > 40 years will be allocated randomly to either standard treatment or titrated oxygen, targeting a blood oxygen saturation of 88–92% during inhalation therapy. The trial will be conducted in the Central Denmark Region and include all ambulance units. The power to detect a 3% 30-day mortality risk difference is 80%. The trial is approved as an emergency trial. Hence, EMS providers will include patients without prior consent. Discussion: The results will provide evidence on whether titrated oxygen delivery outperforms standard high flow oxygen when used to nebulise inhaled bronchodilators in AECOPD treatment. The trial is designed to ensure unselected inclusion of patients with AECOPD needing nebulised bronchodilators—a group of patients that receives high oxygen fractions when treated in the prehospital setting where the only compressed gas is generally pure oxygen. Conducting this trial, we aim to improve treatment for people with AECOPD while reducing their 30-day mortality. Trial registration: European Union Clinical Trials (EUCT) number: 2022-502003-30-00 (authorised 06/12/2022), ClinicalTrials.gov number: NCT05703919 (released 02/02/2023), Universal trial number: U1111-1278-2162. [ABSTRACT FROM AUTHOR]

Introduction: Dysfunction of the diaphragm may ultimately lead to respiratory insufficiency and compromise patient outcome. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been the gold standard to measure diaphragmatic excursion. Ultrasonography can visualize diaphragm excursion and holds many advantages such as no radiation exposure, increased portability and accessibility. However, correlation between fluoroscopy and ultrasonography has never been studied. We aimed to compare fluoroscopic and ultrasound measures of diaphragm excursion to determine if ultrasonography can replace fluoroscopy. Methods: We performed ultrasound and fluoroscopy simultaneously during sniff inspiration and at total inspiratory capacity in patients with chronic obstructive pulmonary disease, heart failure and in healthy volunteers. Cranio-caudal excursion was measured by fluoroscopy and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasonography. Results: Forty-two participants were included. The Pearson correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76–1.04) in a regression analysis. Using the Bland–Altman method, the bias was − 0.39 cm (95% CI − 1.04–0.26), p = 0.24. The Pearson correlation between fluoroscopy and B-mode and area change ultrasonography was high; low for thickness and fraction. All correlations were lower during sniff inspiration compared with inspiratory capacity breathing. Conclusion: Ultrasonography has an acceptable correlation and bias compared to fluoroscopy and can thus be used as the primary tool to evaluate diaphragm excursion. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with a non-shockable rhythm as presenting rhythm in out-of-hospital cardiac arrest (OHCA). Whether the severity of the underlying disease is related to presenting rhythm is unknown. We hypothesized that increased severity of COPD in OHCA patients is associated with an increased prevalence of non-shockable rhythm.Methods: This study included OHCA patients ≥40 years from the Danish Cardiac Arrest Registry (2001-2014). Population-based registries were used to identify chronic diseases and drug prescriptions. COPD was defined as a COPD diagnosis or pharmacological therapy for COPD. The severity of COPD was based on either 1) pharmacological therapy (mild/moderate/severe), 2) admission for exacerbation, 3) prescription for corticosteroids, or 4) forced expiratory volume in 1 s (FEV1). For each of these, a multivariable logistic regression model was used to estimate odds ratios (ORs) for a non-shockable rhythm.Results: Of 33,228 patients with OHCA 7789 (23.4%) had COPD. Of these 6702 (86.0%) had a non-shockable rhythm. Compared to patients without COPD, mild COPD was associated with a non-shockable rhythm (OR = 1.46, 95%CI 1.29-1.65). This association was more pronounced for moderate (OR = 1.78, 95%CI 1.45-2.19) and severe COPD (OR = 2.01 95%CI 1.82-2.20). Recent admission for exacerbation (OR = 2.12, OR 95%CI 1.81-2.49) or prescription for corticosteroids (OR = 1.82, 95%CI 1.55-2.14) was also associated with a non-shockable rhythm. FEV1 ≤ 50% was associated with a non-shockable rhythm compared to FEV1 > 50% (OR = 1.74, 95%CI 1.07-2.82, n = 1122).Conclusion: Incremental severity of COPD is associated with increasing prevalence of a non-shockable rhythm as presenting rhythm in OHCA patients. [ABSTRACT FROM AUTHOR]