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Oxygen (O2) therapy is one of the most commonly applied medications in German hospitals and rescue services. Both hypoxemia and hyperoxemia can be associated with complications. There is currently a lack of reliable data on the use, documentation and surveillance of O2-therapy in German hospitals. We conducted a cross-sectional study on the use of O2 in three hospitals in Hannover, Germany. Of 343 patients included in this study, 20 % received O2 therapy. Twenty-nine percent of patients receiving O2 were at increased risk for hypercapnia. A standard operating procedure (SOP) for O2 therapy was available in only 68 % of patients. In 22 % patients the applied O2-therapy was appropriate in the context of the documented vital parameters. A complete documentation of vital parameters was conducted in only 30 % of all patients and 41 % of patients receiving O2-therapy. A surveillance of O2-therapy using capillary or arterial blood gas analysis was performed in 76 % of patients. Here, 64 % of patients showed normoxemia, 17 % showed hyperoxemia and 19 % of patients showed hypoxemia. The only identifiable predictor for an adequate O2-therapy was a previous invasive ventilation. Our data point towards and inadequate prescription, application and documentation of O2 therapy. The recently released German S3-guideline should be used to increase awareness among physicians and nursing staff regarding the use of O2-therapy to improve O2 therapy and consequently patient safety. Sauerstoff (O2) ist eines der am häufigsten angewendeten Arzneimittel in deutschen Krankenhäusern und im Rettungswesen. Sowohl eine Hypoxämie als auch eine Hyperoxämie sind mit Komplikationen vergesellschaftet. In Deutschland fehlen bislang belastbare Daten zur Anwendung, Dokumentation und Überwachung der O2-Therapie. Eine Querschnittsstudie zur Sauerstoff-Anwendung wurde in 3 Krankenhäusern der maximalen bzw. supramaximalen Versorgung in Hannover im Herbst 2020 durchgeführt. Von 343 erfassten Patienten erhielten 20 % eine O2-Therapie. Bei 29 % der Patienten mit O2-Therapie bestand ein Hyperkapnie-Risiko. Lediglich bei 68 % Patienten mit einer O2-Therapie lag eine SOP zur O2-Anwendung auf den jeweiligen Stationen vor und nur bei 22 % entsprach die gegebene O2-Therapie dem tatsächlichen Bedarf des Patienten. Nur bei 30 % des Gesamtkollektivs und 41 % der Patienten mit O2-Therapie erfolgte eine vollständige Dokumentation der Vitalparameter. Eine Überwachung der O2-Therapie mittels arterieller oder kapillärer Blutgasanalyse (BGA) erfolgte bei 76 % der O2-Patienten. Hier zeigte sich bei 64 % der Patienten eine Normoxämie, bei 17 % eine Hyperoxämie und bei 19 % eine Hypoxämie. Der einzige identifizierbare Prediktor für eine adäquate O2-Therapie war eine vorangegangene Beatmungstherapie. Insgesamt zeigt sich eine suboptimale Indikationsstellung, Anwendung und Kontrolle der Sauerstofftherapie. Schulungen des pflegerischen und ärztlichen Personals zur Verbesserung der Anwendung der O2-Therapie und resultierend auch der Patientensicherheit sind dringend notwendig.

Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. This is due to both to the reallocation of resources toward COVID-19 patients as well as concern for the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant (LTx) recipients. Introduction: New methods such as telemedicine are needed to bridge the gap in follow-up care caused by the pandemic. Materials and Methods: A retrospective analysis of video consultations (VCs) in comparison with on-site visits (OSVs) was performed during a 6-week period in an LTx center in Germany. VC included a structured work-up questionnaire and vital sign documentation. Results: During the 6-week study period, 75 VCs were performed for 53 patients and 75 OSVs by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred through VC. Physician-patient consultations were reduced by 47% compared with the equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high. Discussion: Implementation of VC helped to reduce the need for OSV and thus the risk of SARS-CoV-2 exposure in our patient cohort. This technology can be adopted to provide care for a wide range of chronic illnesses. Conclusions: VC can preserve access to specialist care while reducing SARS-CoV-2 exposure for patients with chronic illnesses during the pandemic.

Despite advances in lung transplantation (LTx), morbidity, and mortality are high. We hypothesized that pleural effusions requiring thoracocentesis lead to poor outcomes after LTx. We performed a single-center retrospective analysis of thoracocenteses after initial hospital discharge in LTx patients between March 2008 and September 2020 to identify risk factors, etiologies, and outcomes. Of the 1223 patients included, 113 patients (9.2%) required a total of 195 thoracocenteses. The cumulative incidence of thoracocentesis was 10.6% at 1 year and 14.2% at 5 years after transplantation. We observed a bimodal distribution of pleural effusion onset with a threshold at 6 months. Late-onset effusions were mostly of malignant or cardiac origin. We observed a high rate of nonspecific effusions (41.5%) irrespective of the timepoint post-transplantation. Patients with late-onset effusions had significantly lower survival compared to a matched controlled group (HR 2.43; 95% CI (1.27-4.62). All pulmonary function parameters were significantly decreased in patients requiring thoracocentesis compared to matched controls. Male sex and re-transplantation were risk factors for pleural effusions. In conclusion, pleural effusions requiring thoracocentesis occur frequently in LTx patients and lead to a reduced long-term allograft function. Late-onset effusions are associated with a lower survival.

Objective This study investigated the effects of supplementing standard informed consent (IC) with a graphic narrative on patient satisfaction, periprocedural anxiety and experience. Methods Patients due to undergo first conscious surveillance bronchoscopy following lung transplantation were randomized to receive IC with (intervention group) or without (control group) a graphic narrative illustrating the procedure. The primary endpoint was overall patient satisfaction with the IC. Key secondary endpoints were change in state anxiety level, as measured by State Trait Anxiety Inventory, and a questionnaire assessing satisfaction with IC and adverse experience during bronchoscopy (judged by patient and examiners). Results Sixty patients were randomized, and 59 patients were included in the analysis (30 intervention-group; 29 control-group). Overall patient satisfaction was higher in the intervention group 9.5 (25Q–75Q: 8.6–9.8) vs. 8.6 (25Q–75Q: 8.1–9.2), p = 0.028). Change in state anxiety level (before vs after informed consent) was similar between the groups. There were no significant differences in adverse experience during bronchoscopy. Conclusion Addition of a graphic narrative illustrating bronchoscopy improved patient satisfaction with IC but did not influence anxiety before and adverse experience during the procedure. Practice implications Supplementing the IC process with a procedure-specific graphic narrative may be a simple tool to improve patient satisfaction.

Background Biological treatments directed against IgE and IL-5 have largely improved outcomes for patients with severe type 2–high asthma. However, a fraction of patients with severe asthma show insufficient treatment outcome under anti-IgE and anti–IL-5/IL-5 receptor α antibodies. Objective To evaluate whether switching to dupilumab was of benefit in patients with insufficient outcome under previous anti-IgE or anti–IL-5/IL-5 receptor α therapy. Methods We retrospectively analyzed 38 patients who were switched to dupilumab from a previous anti-IgE or anti–IL-5/IL-5 receptor α medication because of insufficient outcome. We defined response criteria after 3 to 6 months as an improvement in at least 1 of the following criteria without deterioration in the other criteria, comparing values under dupilumab with values under previous antibody therapy: (1) increase of 3 or more in Asthma Control Test score, (2) 50% or more reduction in oral corticosteroid dose, and (3) FEV1 improvement greater than or equal to 150 mL, and classified patients as responders and nonresponders. Results Switch to dupilumab led to a response in 76% of patients. In the total cohort, Asthma Control Test score increased by a mean of 2.9 (P Conclusions Altogether, we show that a switch to dupilumab in patients with insufficient outcome under previous biological therapy was effective in most patients.

Paracoccidioidomycosis (PCM) is a fungal infection caused by Paracoccidioides brasiliensis and P. lutzii. It is endemic to South and Central America. While PCM frequently remains latent, the disease can reactivate years after the initial infection. As the disease is rare outside the endemic area, and symptoms can mimic other pulmonary diseases, correct diagnosis can be challenging for clinicians in developed countries. In this report, we present the case of a 57-year-old female Venezuelan immigrant with PCM. She was initially misdiagnosed with sarcoidosis and treated with corticosteroids, leading to an exacerbation of the infection requiring intensive care. Because cultivation of Paracoccidioides sp. is slow and unsensitive, we opted for microscopic observation of fungal elements and molecular testing on a tissue biopsy and bronchoalveolar lavage (BAL) together with antibody detection. This allowed the diagnosis of PCM, enabling specific management. PCM and other imported mycoses should be considered as a differential diagnosis in patients originating from South and Central America displaying symptoms suggestive of sarcoidosis. The reviews of this paper are available via the supplemental material section.