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Esophageal pressure (Pes) monitoring is performed during polysomnography (PSG) with a thin, water-filled catheter connected to a transducer. The resulting quantitative assessment of respiratory effort can aid in the accurate diagnosis of sleep-related breathing disorders. This was a prospective observational study using Pes in PSG for thirty patients with chronic respiratory failure (CRF) conducted in the Department of Pulmonary, Critical Care and Sleep Medicine at a tertiary care centre of North India. Sleep scoring was done by conventional method and using esophageal manometry and compared polysomnography normal without esophageal manometry recording (PSGN) and polysomnography with esophageal manometry scoring (PSGE). Apnea hypopnea index (AHI) index was similar in both groups. However, respiratory effort related arousals (RERAs) were diagnosed easily using Pes resulting in significant increase in respiratory disturbance index (RDI) and even reclassification in terms of severity of sleep apnea. Besides, Pes was also useful to distinguish obstructive from central hypopnea which cannot be distinguished by routine PSG which can help guide therapy particularly in chronic respiratory failure patients with hypoventilation. Such patients with hypoventilation often require bilevel positive airway pressure as ventilatory support. Central hypopneas and apneas with hypercapnia may require higher-pressure support, a backup rate or even advanced volume assured modes of ventilation. Thus, it can be concluded that Pes in PSG remains a safe and generally well-tolerated procedure. Use of Pes aids to detect RERA and thereby RDI; a better marker of sleep-related breathing disorder rather than AHI. It also helps in differentiating between obstructive and central hypopnea.

Backgrounds: There are no clinical data comparing the effect of exercise training using high fraction of inspired oxygen (FIO2) in combination with high flow through a high-flow nasal cannula (HFNC) with that of ordinary supplemental oxygen on exercise capacity in subjects with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT). The aim of this study was to compare the effect of 4 weeks of exercise training using high FIO2 in combination with high flow through an HFNC or supplemental oxygen via a nasal cannula on the 6-min walking distance of patients with CRF receiving LTOT.Methods: In this randomized study, 32 patients with CRF due to chronic obstructive pulmonary disease, interstitial pulmonary fibrosis, or bronchiectasis receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a FIO2 of 1.0 (HFNC group; n=16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n=16). Before and after 4 weeks of exercise training, a 6-min walking test, constant-load test, and blood sampling were performed.Results: Prior to exercise training, the endurance time of the constant-load exercise test using an HFNC was significantly longer than that reported with prescribed oxygen in daily LTOT (p=0.004) or a 6 L/min nasal cannula (p=0.0003). Following 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC versus the oxygen group (55.2±69.6 m vs. —0.5±87.3 m, respectively; p=0.04). The plasma levels of adrenaline, noradrenaline, and serum C-reactive protein were significantly decreased only in the HFNC group, after 4 weeks of exercise training.Conclusions: Despite heterogeneity in the effect among patients, exercise training using high FIO2 in combination with high flow through an HFNC is a potentially superior exercise training modality for CRF patients receiving LTOT.Clinical Trial Registration ― http://www.clinicaltrials.gov. Unique identifier: NCT02804243. Registered 13 June 2016.

Background: One of the major challenges of the present century is chronic respiratory failure with a complex, chronic, disabling, and progressive nature, which can gradually affect patient health-related quality of life and their individual and social activities. Therefore, studying its concept will help in recognizing changes in the disease process and predict the status of the disease. This study was prepared to determine health-related quality of life of patients with chronic respiratory failure using a mixed-method approach.Methods and Analysis: The mixed-method approach, with a convergent parallel design, will be used to conduct the research in which the quantitative and qualitative study is performed simultaneously and with the same weight. In the quantitative study section, a cultural and psychometric adaptation of the Severe Respiratory Insufficiency Questionnaire is first translated for patients with severe respiratory failure and then the health-related quality of life dimensions of patients with chronic respiratory failure will be measured using a questionnaire pertaining to the culture of Iranian society in a descriptive-analytical study. Simultaneously with the quantitative study, the researcher will use a qualitative study to explain the perception of patients with chronic respiratory failure and health-related quality of life. Finally, the results of a quantitative study obtained from the analysis of descriptive statistics data (mean and standard deviation) and inferential statistics (analysis of variance, t-test, and regression) are integrated by SPSS software version 18. The results of a qualitative study are the results of conventional content analysis, by comparison and confrontation during interpretation.Discussion & Conclusion: Due to the complexity of the research and for gaining in-depth understanding into the health-related quality of life of patients with chronic respiratory failure, this article will be based on a combination of quantitative and qualitative data. In this research, quantitative and qualitative methods overlap and add to the richness of the data so that the results, beyond the numbers and figures of a quantitative study, will be congruent with an explanation of the concept in a qualitative study and will be discussed and interpreted.

Copyright © 2020 Ferreira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms., Long-term non-invasive ventilation (LTNIV) has been increasingly used in children to manage chronic respiratory failure and airway obstruction. Interfaces are of paramount importance for non-invasive ventilation (NIV) effectiveness and patient compliance. However, historically, the choice of pediatric mask has been limited by the scarce availability of commercial interfaces. In recent years, an increasing number of different masks have been commercialized for children, allowing to increase the number of patients who could benefit from LTNIV. Factors such as the age of the child, disease, craniofacial conformation, type of ventilator and mode of ventilation, and children's and family's preferences should be taken into account when selecting the appropriate mask. Adverse events such as skin lesions, facial growth impairment, and leaks must be prevented and promptly corrected. Humidification is a controversial issue on NIV, but it may be useful in certain circumstances. Regular cleaning and disinfection of interfaces and equipment must be addressed. During follow-up, educational programs, close supervision, and continuous support to children and families are crucial to the success of LTNIV therapy.

BackgroundNoninvasive ventilation (NIV) represents an effective treatment for chronic respiratory failure. However, empirically determined NIV settings may not achieve optimal ventilatory support. Therefore, the efficacy of NIV should be systematically monitored. The minimal recommended monitoring strategy includes clinical assessment, arterial blood gases (ABG) and nocturnal transcutaneous pulsed oxygen saturation (SpO2). Polysomnography is a theoretical gold standard but is not routinely available in many centers. Simple tools such as transcutaneous capnography (TcPCO2) or ventilator built-in software provide reliable informations but their role in NIV monitoring has yet to be defined. The aim of our work was to compare the accuracy of different combinations of tests to assess NIV efficacy.MethodsThis retrospective comparative study evaluated the efficacy of NIV in consecutive patients through four strategies (A, B, C and D) using four different tools in various combinations. These tools included morning ABG, nocturnal SpO2, TcPCO2and data provided by built-in software via a dedicated module. Strategy A (ABG + nocturnal SpO2), B (nocturnal SpO2 + TcPCO2) and C (TcPCO2 + builtin software) were compared to strategy D, which combined all four tools (NIV was appropriate if all four tools were normal).ResultsNIV was appropriate in only 29 of the 100 included patients. Strategy A considered 53 patients as appropriately ventilated. Strategy B considered 48 patients as appropriately ventilated. Strategy C misclassified only 6 patients with daytime hypercapnia.ConclusionMonitoring ABG and nocturnal SpO2is not enough to assess NIV efficacy. Combining data from ventilator built-in software and TcPCO2seems to represent the best strategy to detect poor NIV efficacy.TrialregistrationInstitutional Review Board of the Société de Pneumologie de Langue Française (CEPRO 2016 Georges)

Orientador: Mônica Corso Pereira Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Introdução: a Doença Pulmonar Obstrutiva Crônica (DPOC) abrange uma gama de doenças nas quais os pacientes evoluem com obstrução fixa ao fluxo aéreo detectável por meio de uma prova de função pulmonar (espirometria). Na presença de piora dos sintomas respiratórios e na ausência de opacidades na radiografia de tórax, pode-se estar frente a uma Exacerbação Aguda da DPOC (EADPOC). Eventualmente tais exacerbações levam o paciente a procurar o setor de urgência por agudização da Insuficiência Respiratória Crônica (IRpC), quadro que pode cursar com acidemia respiratória e necessidade de uso de Ventilação Mecânica Não Invasiva (VMNI). Outras doenças além da DPOC podem levar à insuficiência respiratória aguda e apresentar - da mesma forma que nas EADPOC - acidemia respiratória. O objetivo do presente estudo foi descrever as características demográficas, clínicas, funcionais e os desfechos dos pacientes em insuficiência respiratória, em especial dos portadores de DPOC, que fizeram uso de VMNI na Unidade de Emergência Referenciada (UER) do Hospital das Clínicas (HC) - Unicamp; além disso, identificar os intervalos de tempo entre a admissão do paciente na UER e a instalação da VMNI, quando indicada, e os possíveis motivos de eventuais atrasos na condução dos casos. Com esses dados pretende-se propor um protocolo de atendimento das EADPOC na UER - HC, a fim de sistematizar o atendimento e melhorar os desfechos dos doentes. Métodos: trata- se de estudo unicêntrico, observacional (não intervencionista), retrospectivo, realizado por meio de revisão e coleta de dados de 81 pacientes que deram entrada em insuficiência respiratória na UER, sendo 25 portadores de DPOC. Os dados foram buscados a partir dos registros da Unidade Respiratória e do Laboratório de Análises Clínicas. Realizada análise descritiva dos dados, e análise estatística para identificar fatores associados com piores desfechos. Resultados: foram avaliados 81 pacientes, dos quais 25 eram portadores de DPOC. Desses, a maioria era do sexo masculino, com idade de 67 ± 12 anos; 56% estavam em uso de terapia tripla (agonista-beta2 de longa duração+corticóide inalatório+broncodilatador antagonista muscarínico de longa ação), sendo a mediana do tempo porta-máscara de 173 min (26-1.463); desfechos desfavoráveis (óbito ou intubação orotraqueal) ocorreram em 28%. Os dados do tempo porta-máscara e dos desfechos foram semelhantes aos demais pacientes estudados. Pela curva ROC, foi encontrada significância estatística em subgrupos com tempo maior e menor que 560 min. Discussão e Conclusões: As medianas do intervalo de tempo porta-máscara (na amostra total e no subgrupo de DPOC) foram semelhantes às descritas na literatura. Pudemos observar a falta de registro sistematizado das variáveis clínicas, gasométricas, de indicação e monitorização da VMNI na nossa instituição. Pacientes portadores de Insuficiência Cardíaca e em uso de oxigenoterapia domiciliar parecem ser acoplados à VMNI com mais celeridade. Na curva ROC o tempo com melhor especificidade e sensibilidade para desfechos desfavoráveis foi de 560 minutos, o que do ponto de vista prático e clínico é pouco adequado. Não houve diferença quantos aos desfechos entre pacientes com tempo maior ou igual a 240 min versus aqueles com menos de 240min. Considerações finais: espera-se que a implementação de um protocolo visando a sistematização da abordagem terapêutica dessa população tenha impacto positivo no desfecho desses doentes e no padrão de atendimento da equipe multidisciplinar na UER - HC - Unicamp Abstract: Introduction: Chronic Obstructive Pulmonary Disease (COPD) comprises a group of progressive lung diseases characterized by fixed airflow obstruction, which can be identified through spirometry. A sudden worsening of respiratory symptoms without new radiologic opacities is suggestive of an acute exacerbation of COPD. This condition may affect and decompensate patient's basal Chronic Respiratory Failure (CRF). In this context, acute respiratory failure with respiratory acidosis (or primary hypercapnia) may occur, which characterizes a medical emergency that may require Non-Invasive Mechanical Ventilation (NIMV). Other conditions beyond COPD may progress to acute respiratory failure with respiratory acidosis or hypercapnia. In all cases the underlying cause of respiratory acidosis must be treated. The purpose of this study was to describe the demographic, clinical and functional characteristics and outcomes of patients with respiratory failure, especially COPD patients, who have used NIMV at the Referral Emergency Unit (REU) at the Unicamp Clinics Hospital. In addition, determine the time between the admission of patient to the REU and the installation of NIMV, when indicated. Possible causes of delay in this process will be identified. With this data we will propose a protocol to systematize the management of patients with exacerbations of COPD in REU at the Unicamp Clinics Hospital. Methods: this is a retrospective observational (non-interventional) study that was carried with data from 81 cases of using NIMV (79 patients), 25 of them with COPD. Patients were identified from the records of the Respiratory Unit and the Laboratory of Clinical Analyzes and data were collected from medical files. Descriptive and statistical analyses of data were performed to identify factors associated with worse outcomes. Results: Of 25 COPD patients evaluated the majority was male, aged 67 ± 12 years, 56% were using triple therapy (long-acting beta- agonist + inhaled corticosteroid + long-acting muscarinic antagonist). The median of door-to-mask time was 173 min (26-1,463); poor outcomes (death or orotracheal intubation) occurred in 28%. The time door-to-mask and outcome data were similar to the other patients studied. From the ROC curve, statistical significance was found in subgroups with time greater than and less than 560 min. Discussion and Conclusions: The median of door-to-mask time (in the whole sample and in COPD patients) were similar to those described in the literature. At our institution we could observe a lack of systematic registry of the clinical characteristics, arterial blood gases, timing of indication and monitoring NIMV on the medical records. Patients with heart failure and using long-term oxygen therapy appear to be evaluated and have access to VMINI more quickly. In the ROC curve the time with the best specificity and sensitivity for poor outcomes was 560 minutes, which from a practical and clinical point of view is not adequate. There was no difference in outcomes among patients with time greater than or equal to 240 min versus those with less than 240 minutes. Final comments: it is expected that the implementation of a protocol aimed at systematizing the therapeutic approach of this population will have a positive impact on patients¿ outcomes and on the standard of multidisciplinary care in the REU at the Unicamp Clinics Hospital Mestrado Eficácia e Efetividade de Testes Diagnósticos e Protocolos de Tratamento em Saúde Mestre em Ciências

Die Zahl der Patienten im prolongierten Weaning steigt infolge des zunehmenden Alters und der Komorbidität der Patienten sowie des technischen Fortschrittes in der Chirurgie und der Intensivmedizin kontinuierlich an. Die Daten des WeanNet-Registers zeigen, dass über die Hälfte (64 %) der von der Intensivstation in ein spezialisiertes Weaningzentrum verlegten Patienten vom Respirator definitiv entwöhnt werden konnte. Mit einem Weaningversagen waren eine längere Beatmungsdauer vor Verlegung auf die Weaningstation, gefolgt von einem niedrigen Body-Mass-Index, vorbestehende neuromuskuläre Erkrankungen und ein fortgeschrittenes Alter assoziiert. Die Zahl der Patienten mit außerklinischer Beatmung, die wegen der Kontrolle der Beatmung oder eines Notfalls rehospitalisiert werden mussten, hat sich in Deutschland zwischen 2006 und 2016 vervierfacht. Die außerklinische invasive Beatmung bzw. Langzeit-NIV (nichtinvasive Beatmung) geht häufig mit einem deutlichen Autonomieverlust und geringer Lebensqualität einher, sodass deren Beginn in Zusammenschau mit der Komorbidität des Patienten und dem Patientenwillen sorgfältig geprüft, die Indikation regelmäßig reevaluiert und ggf. eine Entscheidung zur Therapiezieländerung getroffen werden sollte. Die Einstellung auf eine außerklinische Beatmung nach erfolglosem prolongiertem Weaning sollte in einem spezialisierten Weaningzentrum durchgeführt werden. Für das Behandlungskonzept von Patienten mit invasiver außerklinischer Beatmung bzw. NIV ist ein Weaningzentrum verantwortlich. Abhängig von der Infrastruktur und Vernetzung des jeweiligen Weaningzentrums ist es grundsätzlich auch möglich, die ambulante Betreuung klinisch stabiler Patienten im Rahmen eines Kooperationsmodells gemeinsam mit in der Beatmungsmedizin erfahrenen niedergelassenen Pneumologen durchzuführen.

"Many seemingly mundane aspects of the sleep laboratory can have outsized effects on the quality of polysomnographic data obtained from, and care provided to, patients. This is particularly true when performing polysomnography on patients with chronic respiratory failure due to various causes. This article uses a disease-based approach to review physical and protocol-based accommodations that should be considered when performing polysomnography on this patient population."

Noninvasive ventilation has become an increasingly common treatment strategy for patients with diverse conditions involving chronic respiratory failure. An intimate understanding of various advanced respiratory devices and modes is essential in the management of these patients. Pressure-limited modes of ventilation are more commonly used than volume modes for noninvasive ventilation owing to enhanced patient comfort and synchrony with the ventilator, as well as improved leak compensation. Common pressure modes include spontaneous/timed and pressure control, with volume-assured pressure support being an additive feature available on certain devices. Evidence guiding the optimal mode of ventilation for specific diseases is limited.

A significant body of literature supports the benefit of noninvasive ventilation (NIV) for acute hypercapnia in the setting of exacerbations of chronic obstructive pulmonary disease (COPD). In those with severe COPD with chronic hypercapnic respiratory failure, however, the role of NIV has been more controversial. This article reviews the physiologic basis for considering NIV in patients with COPD, summarizes existing evidence supporting the role of NIV in COPD, highlights the patient population and ventilatory approach most likely to offer benefit, and suggests a potential clinical pathway for managing patients.

This review focuses on the delivery of non-invasive ventilation—i.e., intermittent positive-pressure ventilation—in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.

Michele Vitacca,1 Alberto Malovini,2 Bruno Balbi,3 Maria Aliani,4 Serena Cirio,5 Antonio Spanevello,6,7 Claudio Fracchia,8 Mauro Maniscalco,9 Giacomo Corica,10 Nicolino Ambrosino,8 Mara Paneroni1 1Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy; 2Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Informatics and Systems Engineering for Clinical Research of the Institute of Pavia, Pavia, Italy; 3Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Veruno, Novara, Italy; 4Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Cassano Delle Murge, Bari, Italy; 5Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Pavia, Pavia, Italy; 6Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Tradate, Varese, Italy; 7University of Insubria, MACRO, Varese, Italy; 8Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Montescano, Pavia, Italy; 9Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Telese, Benevento, Italy; 10Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate of the Institute of Lumezzane, Brescia, ItalyCorrespondence: Michele VitaccaIstituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 4, Pavia 27100, ItalyEmail michele.vitacca@icsmaugeri.itBackground: The Barthel Index dyspnea (BId) is responsive to physiological changes and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). However, the minimum clinically important difference (MCID) has not been established yet.Aim: To identify the MCID of BId in patients with COPD stratified according to the presence of chronic respiratory failure (CRF) or not.Materials and Methods: Using the Medical Research Council (MRC) score as an anchor, receiver operating characteristic curves and quantile regression were retrospectively evaluated before and after pulmonary rehabilitation in 2327 patients with COPD (1151 of them with CRF).Results: The median post-rehabilitation changes in BId for all patients were − 10 (interquartile range = − 17 to − 3, p< 0.001), correlating significantly with changes in MRC (r = 0.57, 95% CI = 0.53 to 0.59, p< 0.001). Comparing different methods of assessment, the MCID ranged from − 6.5 to − 9 points for patients without and − 7.5 to − 12 points for patients with CRF.Conclusion: The most conservative estimate of the MCID is − 9 points in patients with COPD, without and − 12 in those with CRF. This estimate may be useful in the clinical interpretation of data, particularly in response to intervention studies.Keywords: activities of daily life, breathlessness, dyspnea, chronic respiratory failure, exercise training, health related quality of life, rehabilitation

Vaikų lėtinis kvėpavimo nepakankamumas (LKN) – tai reta, tačiau vis dažniau pasitaikanti problema. Medicinos pasiekimai ir tobulėjanti sveikatos priežiūra lemia didesnį vaikų išgyvenamumą per anksti gimus ar sergant įvairiomis sunkiomisligomis, kurios sukelia kvėpavimo sutrikimus ir LKN. LKN sutrikimo priežastimis gali būti prasta kvėpavimomechanika, pakitęs kvėpavimo takų praeinamumas, sutrikusi kvėpavimo reguliacija, plaučių parenchimos bei kraujotakos ligos. Tarp kitų įvairių priežasčių, vaikams svarbiausios yra nervų raumenų ir lėtinės pūlinės plaučių ligos. Vaikams skirtingai nei suaugusiems LKN dažnai gali būti ilgainiui praeinanti būklė, o ne progresuojanti liga, todėl labai svarbu laiku pastebėti ir diagnozuoti šią būklę,o nustačius LKN priežastis bei numačius prognozę, adekvačiai gydyti. LKN gydymo sėkmė šiuolaikinėje medicinoje labiausiai priklauso nuo ilgalaikės multidisciplininės paciento priežiūros, darniai ir veiksmingai veikiančios visose sveikatos priežiūrosgrandyse. Tikslas – panaikinti priežastį arba sumažinti pagrindinės priežasties, sukėlusios LKN, padarinius ir pagerinti vaiko bei jį globojančių asmenų gyvenimo kokybę. Svarbiausi gydymo uždaviniai: pagrindinės ligos gydymas ir ilgalaikės deguonies terapijos, ir (arba) dirbtinės plaučių ventiliacijos pritaikymas namuose. Straipsnyje išsamiau aptariamos vaikų LKN priežastys, svarbiausių diagnostikos metodų ypatumai vaikams, taip pat konservatyvaus vaikų gydymo rekomendacijos, atsižvelgiant į teisinį šių paslaugų reguliavimą šalyje.

Method: Effectiveness of pulmonary rehabilitation (PR) is still uncertain in elderly people with severe COPD, particularly those with chronic respiratory failure (CRF). The aim of this study was to determine whether being elderly impacts the short and long-term effects of a home-based PR in people with COPD and CRF. Methods: In this retrospective study, 480 people with COPD and CRF were divided into those ≤ 70 (n=341) and those > 70 years of age (n=139). All participants underwent 8-weeks of home-based PR, consisting in one-weekly individualized home session. Six-minute stepper test (6MST), timed-up and go test (TUG), hospital anxiety and depression scale, and visual simplified respiratory questionnaire (VSRQ) were assessed at baseline (T0), and at 2 (T2) and 14 (T14) months after baseline. Individuals improving beyond the clinically important difference for at least one of these variables were considered responders to PR. Results: The older group was characterized by less current smokers (p Conclusion: Regardless of the age, individualized home-based PR was effective for people with COPD and CRF at short and long term, with the exception of VSRQ score whose initial improvement was lost at T14.

Introduction: Home Mechanical Ventilation (HMV) reduces mortality in chronic respiratory failure. The number of patients requiring prolonged HMV is increasing, but current home surveillance has not been sufficient to ensure consistent therapeutic efficacy. The CAI_Vent Program proposes effective monitoring and accessibility to experienced respiratory care. Objectives: Describe a one-year (2019) impact of the CAI_Vent program for prolonged HMV patients (> 12hday). Methods: Prolonged HMV patients were visited monthly at home and had access to a 24-hour telephone line. Monitoring was performed by data reading of the ventilator memory card. One-year data from 2019 on the number of Emergency Episodes (EE), hospital length of stay (LOS) and number of outpatient hospital consults (OHC) were recorded and compared with the same data from 2018 (time period without access to the CAI_Vent program). Results: 42 patients (17 women) were included with a mean age of 54.2 ± 19.57 years with the following diagnoses: COPD (n = 18), NMD (n = 13), OHS (n = 4), CWD (n = 4), ILD (n = 3), with an average ventilation use of 17.6 ± 4.5 hours / day. During the one-year analysis, 328 home visits and 130 telephone calls were recorded. Compared to 2018, in 2019 we observed a reduction of total hospital LOS (558 days versus 163 days), a reduction of EE (110 versus 47) and a reduction in the number of OHC (146 versus 91) Conclusion: An integrated program for prolonged HMV patients promotes better monitoring, early interventions and a reduction in hospital resources usage

Background: Arterial blood gases in patients with chronic respiratory acidosis have a distribution in which the pH decreases as PaCO2 increases on the PaCO2-pH plane. The degree of renal correction can be determined above and below the approximation line. To investigate whether the degree of renal correction is associated with patients’ prognosis. Methods: The prognosis of the group with larger degree of renal correction and the group with smaller degree of renal correction in arterial blood gas at the start of observation (0m-PaCO2 and 0m-pH) were compared. Results: The analysis was performed in 325 cases of chronic respiratory failure (236 LTOT cases and 89 NIV cases). All 325 patients were divided by the approximation line (pH = -0.0025 * PaCO2 + 7.5253 (R2 = 0.40)) into two groups, and there was no significant difference in prognosis (p = 0.60). The 236 LTOT patients were divided into two groups by pH = -0.0026 * PaCO2 + 7.5289 (R2 = 0.34), and the prognosis was not significantly different (p = 0.61). The 89 NIV patients were divided into two groups by pH = -0.0021 * PaCO2 + 7.4964 (R2 = 0.28), and there was no significant difference in prognosis (p = 0.64). Similar results were obtained by analysis for patients with COPD, interstitial pneumonia, and restrictive thoracic disease. Conclusion: The degree of renal correction in patients with chronic respiratory acidosis may not affect prognosis.

Background and Aim: The Barthel Dyspnoea Index (BDi) is responsive to change in patients with chronic obstructive pulmonary disease (COPD). However, the minimum clinically important difference (MCID) has not been established. We aimed to identify the MCID for the BDi using anchor-based and distribution-based methods. Methods: In a retrospective analysis we assessed BDi before and after inpatient pulmonary rehabilitation in 2328 patients with COPD (1152 with chronic respiratory failure - CRF). The Medical Research Council (MRC) score was measured concurrently as anchors. We used receiver operating characteristic (ROC) curves, linear regression, and distribution-based methods to estimate the MCID for the BDi; we included only patients with paired BDi scores in the analysis. Results: The mean change for the whole group in BDi score with pulmonary rehabilitation was -10 (IQR -17 : -3; p Conclusions: The most conservative estimate of the MCID for the BDi is -9 points in patients with COPD and -12 in patients without CRF. This estimate could be useful in the clinical interpretation of BDi data, particularly in response to intervention studies.

Non-invasive ventilation is increasingly used in children for acute and chronic respiratory failure. Ventilators available for clinical use have different levels of complexity, and clinicians need to know in detail their characteristics, setting variables, and performances. A wide range of ventilators are currently used in non-invasive ventilation including bi-level ventilators, intermediate ventilators, and critical care ventilators. Simple or advanced continuous positive airway pressure devices are also available. Differences between ventilators may have implications on the development of asynchronies and air leaks and may be associated with discomfort and poor patient tolerance. Although pressure-targeted (controlled) mode is preferable in children because of barotrauma concerns, volume-targeted (controlled) ventilators are also available. Pressure support ventilation represents the most used non-invasive ventilation mode, as it is more physiological. The newest ventilators allow the clinicians to use the hybrid modes that combine the advantages of volume- and pressure-targeted (controlled) ventilation while limiting their drawbacks. The use of in-built software may help clinicians to optimize the ventilator setting as well as to objectively monitor patient adherence to the treatment. The present review aims to help the clinician with the choice of the ventilator and its ventilation modalities to ensure a successful non-invasive ventilation program.

Home oxygen therapy allows patients requiring long-term oxygen therapy to receive care at home and helps improve the prognosis of patients with chronic respiratory failure. The usage conditions of oxygen concentrators, which are used to supply gaseous oxygen, and the effects of oxygen inhaled at a prescribed flow rate have not been confirmed in adequate detail. As a result of advances in information and communications technology, internet communication functions can now be incorporated into medical devices installed in patients' homes. This allows time-series data on oxygen concentrator usage and biological variables to be stored on a server and accessed remotely by health care providers, enabling them to check the validity of home oxygen therapy and intervene appropriately. In Japan, telemonitoring of home oxygen therapy is covered by social insurance systems and is recognized as a new medical technology. This article reviews the usefulness of telemonitoring of home oxygen therapy and describes the cloud-based analytical system we have developed.

We herein report a rare case of pulmonary sarcoidosis leading to chronic respiratory failure with restrictive ventilatory impairment during a 53-year-long observation period. Nine years after the histological diagnosis of stage I sarcoidosis on chest X-ray in a woman in her 20s, she developed bilateral reticular and granular opacities on chest computed tomography and was started on prednisone for 18 years. Seven years after prednisone withdrawal, these persisting opacities around the bronchovascular bundle, including a central-peripheral band, had progressed, forming traction bronchiectasis clusters and peripheral cysts, some of which developed continuously at the distal side of these clusters, with eventual upper lobe shrinkage.

This study aimed to clarify the incidence of infectious diseases and the associated risk factors among patients who use visiting nursing services in Japan. We conducted a one-year follow up cohort study with 419 participants. The incidence and period prevalence rate of infectious diseases were 0.63 and 15.0%, respectively. In the multiple logistic regression analysis, the presence of chronic respiratory failure, Parkinson's disease, dermatosis other than pressure ulcers, and the inability to perform oral self-care were significantly related to the contraction of an infectious disease.

Background It has been shown that home mechanical ventilation improves quality of life, but it has not been widely studied which particular patient groups benefit the most from starting this type of therapy. The purpose of this prospective observational study was to evaluate quality of life change patterns 6 months after initiation of home mechanical ventilation in patients suffering from chronic respiratory failure using patient reported outcomes. Methods We enrolled 74 chronic respiratory failure patients starting invasive or noninvasive home mechanical ventilation through the Semmelweis University Home Mechanical Ventilation Program. Quality of life was evaluated at baseline and at 6 months after initiation of home mechanical ventilation using the Severe Respiratory Insufficiency Questionnaire. Results Overall quality of life showed 10.5% improvement 6 months after initiation of home mechanical ventilation (p p = 0.015), Sleep and attendant symptoms (19.3%, p p p = 0.660). Severely impaired patients showed the greatest improvement (CC = -0.328, p p = 0.025), with chronic obstructive pulmonary disease and obesity hypoventilation syndrome patients showing the greatest improvement, while amyotrophic lateral sclerosis patients showed no improvement in quality of life. We found that patients who were started on long term ventilation in an acute setting, required oxygen supplementation and had low baseline quality of life, showed the most improvement during the six-month study period. Conclusions Our study highlights the profound effect of home mechanical ventilation on quality of life in chronic respiratory failure patients that is indifferent of ventilation interface but is dependent on initial diagnosis and some baseline characteristics, like acute initiation, oxygen supplementation need and baseline quality of life. Trial registration This study was approved by and registered at the ethics committee of Semmelweis University (SE TUKEB 251/2017; 20th of December, 2017).

Several factors involving ventilation and gas exchange limit the exercise performance of patients with severe chronic respiratory diseases. Clinical studies have clarified that training individuals by adding noninvasive ventilation could produce several beneficial effects including unloading of respiratory muscles and therefore improving gas exchange, dyspnoea and exercise duration. However, further studies are warranted to investigate the effect of optimal training duration and intensity of noninvasive ventilation assisted exercise training in patients with chronic respiratory failure.

Home mechanical ventilation (HMV) is a method of treatment in children with sleep-disordered breathing (SDB) and alveolar hypoventilation regardless of primary disease. The goal of the study was to describe the changes in the HMV program in Serbia during the last two decades. Cross-sectional retrospective study included data from the national HMV database from 2001 until 2019. HMV was initiated in clinically stable patients after the failure to wean from mechanical ventilation succeeded acute respiratory deterioration or electively after the confirmation of SDB and alveolar hypoventilation by sleep study or continuous transcutaneous capnometry and oximetry. The study included 105 patients (50 ventilated noninvasively and 55 ventilated invasively via tracheostomy). The median age at the time of HMV initiation was 6.2 years (range: 0.3–18 years). Invasive ventilation had been initiated significantly earlier than noninvasive ventilation (NIV) (p < 0.01), without difference in duration of ventilatory support (p = 0.95). Patients on NIV were significantly older (p < 0.01) than those ventilated invasively (13 and 1.5 years, respectively). Average waiting time on equipment had been shortened significantly—from 6.3 months until 2010 to 1 month at the end of the study (p < 0.01). Only 6.6% of patients had obstructive sleep apnea syndrome (OSAS) requiring HMV. During the study period, 24% patients died, mostly due to uncontrolled infection or progression of underlying disease. Availability and shortened waiting time for the equipment accompanied by advanced overall health care led to substantial improvements in the national HMV program. However, future improvements should be directed to systematic evaluation of SDB in patients with OSAS, early diagnosis of nocturnal hypoventilation, and subsequent timely initiation of chronic ventilation.

Home oxygen therapy (HOT), also known as long-term oxygen therapy, is prescribed to patients with chronic respiratory failure (CRF) due to advanced respiratory diseases, as it has been shown to improve the prognosis of patients with chronic obstructive pulmonary disease (COPD). However, the therapeutic impact of HOT does not fully reflect the “socialization” of patients, which is one of the final goals of “comprehensive pulmonary rehabilitation”, proposed by the Japanese Respiratory Society. Since working is one form of socialization, we evaluated a 55-yr-old worker prescribed with HOT for the management of advanced COPD to elucidate and assess the social barriers experienced by HOT users. This case demonstrates a variety of factors affecting patients, respiratory physicians, occupational physicians, and management teams, which prevents patients from working. By elucidating these factors and seeking solutions, the promotion of the “harmonization of work with treatment and prevention” will both improve working environments and encourage CRF patients to continue working, leading to better socialization. Thus, the “harmonization of working with treatment and prevention” for CRF patients is a core goal for the promotion of both “health and productivity management” and “comprehensive pulmonary rehabilitation.”

Introduction Mycobacterium avium complex can be responsible for a number of different radio-clinical presentations, ranging from invasive infections to hypersensitivity pneumonitis due to repeated inhalation of antigens. The diagnosis of hypersensitivity pneumonitis is clinical, radiological, biological and microbiological. Case report A 61-year-old male developed a hypersensitivity pneumonitis reaction to non-tuberculous mycobacteria, following the repeated use of his own spa, which later evolved into chronic respiratory failure. The diagnosis was made via an environmental analysis. Immunosuppressive treatment comprising corticosteroids and methotrexate led to moderate improvement, but may also have been responsible for the development of a M. intracellulare abscess. Despite 12 months of well-conducted antibiotic treatment, the evolution was unfavourable, with a relapse of a M. intracellulare infection three months after the end of treatment, followed by the patient's death. Conclusion Hypersensitivity pneumonitis reaction to non-tuberculous mycobacteria should be considered in patients who have their own spa. In the absence of microbiological identification, environmental analysis may guide the diagnosis. A fatal evolution of PHS is infrequent but prognosis may depend on the degree of associated fibrosis., Introduction Le complexe Mycobacterium avium (MAC) peut donner plusieurs tableaux radiocliniques allant d’une infection invasive à une pneumopathie d’hypersensibilité (PHS) secondaire à des inhalations répétées d’antigènes. Le diagnostic de PHS repose sur un faisceau d’arguments cliniques, radiologiques, biologiques et microbiologiques. Observation Nous rapportons le cas d’un homme de 61 ans qui a développé une PHS à mycobactéries atypiques secondaire à l’utilisation répétée d’un spa personnel, compliquée d’une insuffisance respiratoire chronique, dont le diagnostic a été fortement orienté par l’analyse environnementale. Le traitement immunosuppresseur par corticoïdes et méthotrexate a permis une amélioration modérée mais a aussi probablement favorisé l’apparition d’un abcès à Mycobacterium intracellulare . Malgré un traitement antibiotique bien conduit pendant douze mois, l’évolution fut défavorable avec récidive de l’infection à M. intracellulare trois mois après l’arrêt de celui-ci, puis décès du patient. Conclusion La PHS à mycobactéries doit être suspectée chez les patients disposant d’un spa. En l’absence de documentation microbiologique, l’analyse environnementale peut orienter le diagnostic. L’évolution défavorable des PHS n’est pas habituelle, le pronostic dépend du degré de fibrose sous-jacent.

One of the primary indications for noninvasive ventilation (NIV) is for the treatment of acute respiratory failure. NIV is often used in attempts to avoid tracheal intubation, and it is also commonly utilized for managing chronic respiratory failure in neuromuscular disease as well as other

Gene expression profiles of patients with progressive sarcoidosis, most of whom had evidence of fibrosis on imaging, have been reported to be similar to those of patients with inflammatory hypersensitivity pneumonitis, while expression profiles in progressive sarcoidosis did not resemble those of idiopathic pulmonary fibrosis. However, it is not known whether specific parenchymal features discerned on computed tomography (CT) imaging can predict development of fibrosis in pulmonary fibrosis. We herein describe a rare case of pulmonary sarcoidosis with honeycomb lung‐like structures developing as a result of concentration of traction bronchiectasis distally, predominantly in both lower lung fields, which developed through shrinkage of consolidations comprising a “central–peripheral band” detected in a woman in her 60s, with non‐caseating epithelioid granuloma. To our knowledge, this is the first case demonstrating the distinctive morphology and developmental process of honeycomb lung‐like structures in fibrotic pulmonary sarcoidosis., We herein describe the first case, to our knowledge, of pulmonary sarcoidosis with honeycomb lung‐like structures developing as a result of concentration of traction bronchiectasis distally, predominantly in both lower lung fields, which developed through shrinkage of consolidations comprising a “central–peripheral band” detected in a woman in her 60s, with non‐caseating epithelioid granuloma.

The severe acute respiratory syndrome (SARS)‐CoV‐2 pandemic continues to produce a large number of patients with chronic respiratory failure and ventilator dependence. As such, surgeons will be called upon to perform tracheotomy for a subset of these chronically intubated patients. As seen during the SARS and the SARS‐CoV‐2 outbreaks, aerosol‐generating procedures (AGP) have been associated with higher rates of infection of medical personnel and potential acceleration of viral dissemination throughout the medical center. Therefore, a thoughtful approach to tracheotomy (and other AGPs) is imperative and maintaining traditional management norms may be unsuitable or even potentially harmful. We sought to review the existing evidence informing best practices and then develop straightforward guidelines for tracheotomy during the SARS‐CoV‐2 pandemic. This communication is the product of those efforts and is based on national and international experience with the current SARS‐CoV‐2 pandemic and the SARS epidemic of 2002/2003.

Les maladies professionnelles, qui se manifestent surtout chez les mineurs et les lapidaires, ne sont pas encore maitrisees a Madagascar. Les conditions de travail et la pauvrete constituent des facteurs de gravite des pneumoconioses. Dans cet article deux cas de jeunes freres lapidaires sont rapportes, atteints d’une silicose diagnostiquee au stade tardif refletant cette realite. La symptomatologie etait dominee par une dyspnee chronique d’aggravation progressive compliquee d’une insuffisance respiratoire chronique et d’un cœur pulmonaire chronique chez les deux patients. Les investigations etaient limitees par le manque de moyens financiers. La radiologie a montre une image de miliaire pour le premier patient, et une atelectasie de deux lobes pulmonaires a droite pour le deuxieme. Le traitement etait base sur l’usage de corticoides, de bronchodilatateurs et surtout sur l’oxygenotherapie de longue duree. Leur evolution clinique a ete favorable au debut de l’hospitalisation mais s’est deterioree au bout de quelques semaines. La silicose est une affection grave, notamment par ses complications. A Madagascar, le systeme de sante jouerait un grand role dans sa prevention. Occupational diseases, which occur especially among mineworkers and stonecutters, are yet to be controlled in Madagascar. Working conditions and poverty are factors of pneumoconiosis gravity. This paper focuses on two cases of two young stonecutters’ brothers affected by a silicosis diagnosed at a late stage, reflecting this reality. The symptomatology was dominated by a chronic dyspnea with gradual worsening, complicated by chronic respiratory failure and chronic cor pulmonale in the two patients. The investigations were limited by the lack of financial resources. Radiology showed miliary for the first patient and two lobes’ atelectasis for the second patient. The treatment was based on the use of corticoids and bronchodilators, most especially, on long term oxygen therapy. Their clinical evolution was successful at the beginning of their hospitalization but later worsened after some weeks. Silicosis is a serious condition, particularly by its complications. In Madagascar, the health care system aims to play a significant role in its prevention.

BACKGROUND: Respiratory ICUs (RICUs) have recently been implemented in France to fill the gap between ICUs and respiratory wards for patients who will require prolonged mechanical ventilation (PMV). The aim of this study was to describe the outcomes of subjects with tracheostomy who were undergoing PMV before and after implementing a RICU in our hospital. METHODS: Two cohorts were studied and followed up for 1 year. Cohort 1 included 66 subjects from December 2010 to December 2012, before implementing the RICU. Cohort 2 included 103 consecutive subjects included in the RICU from January 2016 to June 2017. RESULTS: In cohort 2, lung and airway diseases were the main causes of chronic respiratory failure in 91.3% of the subjects versus 47.0% of the subjects in cohort 1 (P CONCLUSIONS: Implementing a RICU improved the outcomes of the subjects with tracheostomy who were undergoing PMV by reducing the length of stay and increasing complete or partial weaning. However, the 1-year survival remained unchanged.

Chronic respiratory failure describes a clinical state when the arterial Po2 breathing air is less than 8.0 kPa, which may or may not be associated with hypercapnia (defined as Pco2 more than 6.0 kPa (45 mm Hg)). Four processes cause arterial hypoxaemia due to inefficient pulmonary gas exchange—ventilation–perfusion (V/Q) mismatch, hypoventilation, diffusion limitation, and true shunt, with the most important of these being V/Q mismatching. The arterial CO2 is increased by inadequate alveolar ventilation and/or V/Q abnormality. A wide range of disorders can cause chronic respiratory failure, with the commonest being chronic obstructive pulmonary disease, interstitial lung diseases, chest wall and neuromuscular diseases, and morbid obesity.

Rationale Viral respiratory infections, including SARS-CoV-2 infection, can trigger respiratory symptoms among patients suffering from chronic respiratory diseases, leading to exacerbations and hospitalizations. Despite the tropism of SARS-CoV-2 into the respiratory tract, chronic respiratory diseases do not seem to be risk factors for severe forms of COVID-19. Objectives To assess whether hospitalized patients for COVID-19 with chronic respiratory diseases were at lower risk of developing a severe form than other patients. Methods This French study included patients admitted to hospital in COVID-19 ward, suffering from a SARS-CoV-2 infection, diagnosed on RT-PCR or chest computed tomography associated with clinical symptoms, from March 15 to June 30, 2020. Ambulatory patients who were tested in the emergency department and patients with severe hypoxaemia requiring intensive care were not included. All data were collected from electronic medical records up to discharge of the patient. Main Results 617 patients were included: 125 with a chronic respiratory disease, mainly chronic obstructive pulmonary disease (45%) and asthma (30%). The percentage of patients scoring 6 or higher on the WHO Clinical Progression Scale during hospital stay was lower in patients with chronic respiratory disease compared to those without chronic respiratory disease (21.6% versus 31.3%, respectively, p = 0.03). Among patients with chronic respiratory disease, temperature above 38 °C on admission (OR 16.88 (95% CI 4.01–71.00)), lymphopenia (OR 5.08 (1.25–20.72)), CPAP therapy (OR 4.46 (1.04–19.17)) and age (OR 1.09 (1.02–1.16)) were associated with an increased risk to reach a score of 6 or above. Conclusions Hospital admissions in COVID-19 ward of patients suffering from chronic respiratory diseases are at lower risk of developing a severe form of COVID- 19, especially in patients with chronic obstructive pulmonary disease or asthma. Prospective studies would confirm our results and allow to better organize the follow-up of these patients in a pandemic period.

Background Home mechanical ventilation is an established treatment for chronic respiratory failure resulting in improved survival and quality of life. Technological advancement, evolving health care reimbursement systems and newly implemented national guidelines result in increased utilization worldwide. Prevalence shows great geographical variations and data on East-Central European practice has been scarce to date. The aim of the current study was to evaluate prevalence and characteristics of home mechanical ventilation in Hungary. Methods We conducted a nationwide study using an online survey focusing on patients receiving ventilatory support at home. The survey focused on characterization of the site (affiliation, type), experience with home mechanical ventilation, number of patients treated, indication for home mechanical ventilation (disease type), description of home mechanical ventilation (invasive/noninvasive, ventilation hours, duration of ventilation) and description of the care provided (type of follow up visits, hospitalization need, reimbursement). Results Our survey uncovered a total of 384 patients amounting to a prevalence of 3.9/100,000 in Hungary. 10.4% of patients received invasive, while 89.6% received noninvasive ventilation. The most frequent diagnosis was central hypopnea syndromes (60%), while pulmonary (20%), neuromuscular (11%) and chest wall disorders (7%) were less frequent indications. Daily ventilation need was less than 8 h in 74.2%, between 8 and 16 h in 15.4% and more than 16 h in 10.4% of patients reported. When comparing sites with a limited ( 50 patients) case number, we found the former had significantly higher ratio of neuromuscular conditions, were more likely to ventilate invasively, with more than 16 h/day ventilation need and were more likely to provide home visits and readmit patients (p

RATIONALE: Physiologically stable ventilator dependent patients experiencing protracted intensive care unit (ICU) admission pose substantial burden on ICU bed capacity. We developed a progr...

We report a fatal tracheoinnominate artery fistula (TIF) in a 13-year-old female patient with long-term tracheostomy tube dependence due to chronic respiratory failure. Thirteen years after placement of her tracheostomy tube, the patient experienced two separate episodes of sentinel bleeding prior to a fatal hemorrhagic event. Diagnostic evaluation after the sentinel events was mostly nonconclusive. This case highlights the risk of TIF in pediatric age group, even years after initial tracheostomy tube placement, and the need for a high index of suspicion for TIF when children present with unexplained tracheal bleeding.

Introduction: The aim of the study was to measure the concentrations of vitamin D in serum of COPD patients with chronic respiratory failure in comparison to healthy control group. The correlation between the levels of vitamin D in serum and the selected clinical, spirometric and blood gas parameters was the additional aim of the study. Material and methods: The study included 61 patients with diagnosed COPD in stadium of chronic respiratory failure (45 men and 16 women) and 37 healthy controls (19 men and 18 women). The following procedure were performed in all studied subjects: detailed history (especially: daily activity, diet, tobacco and alcohol use), post-bronchodilator spirometry, assessment of 25(OH)D in serum and for COPD group only blood gas analysis. Recruitment for the study was conducted from November to April. Statistical analysis was performed using the following statistical methods: t-Student test, Mann-Whitney U test, Spearman correlation test and Chi-kwadrat test. Results: There was no significant differences between COPD and control group for the levels of 25(OH)D in serum. Median and lower; upper quartile were respectively following: 24.75 nmol/l (16.9; 36.4) vs. 24.06 nmol/l (16.3; 37.2), p = 0.69. Vitamin D deficiency was present in 60 COPD patients (98.3% of all patients) and in 36 control group subject (97.3% of all healthy volunteers). The difference was not statistically significant. The levels of vitamin D in serum did not significantly correlated with any of studied parameters (spirometry, blood gas, age, the level of activity, BMI, tobacco smoke exposure and others). However, the level of activity in COPD group correlated positively with spirometry values and negatively with age and number of exacerbations. Conclusion: The results of the study showed that in autumn-winter time in Poland there are very frequent deficiency of vitamin D in serum not only in COPD patients in respiratory failure stage but also in elderly healthy persons. However, in contrary to expectations the deficiency of vitamin D in COPD patients with respiratory failure were similar to that seen in healthy persons.

Birsen Ocakli, Eylem Acarturk, Emine Aksoy, Sinem Gungor, Fulya Ciyiltepe, Selahattin Oztas, Ipek Ozmen, Meltem Coban Agca, Cuneyt Salturk, Nalan Adiguzel, Zuhal Karakurt Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: The aim of this study was to evaluate the impact of exposure to biomass smoke vs cigarette smoke on serum inflammatory markers and pulmonary function parameters in patients with chronic respiratory failure (CRF).Patients and methods: A total of 106 patients with CRF divided into age and gender-matched groups of cigarette-smoke exposure (n=55, mean [SD] age: 71.0 [12.0] years, 92.7% were females) and biomass smoke exposure (n=51, mean [SD] age: 73.0 [11.0] years, 94.1% were females) were included in this retrospective study. Data on patient demographics (age and gender), inflammatory markers, including neutrophil-to-lymphocyte ratio, C-reactive protein, platelet/mean platelet volume ratio, arterial blood gas analysis, and pulmonary function test findings, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were obtained from medical records.Results: Carbon dioxide partial pressure levels were significantly higher in the biomass smoke exposure than in the cigarette smoke exposure group (mean [SD] 51.0 [8.0] vs 47.0 [8.0] mmHg, p=0.026, respectively). Spirometry revealed similarly low levels for FEV1 (%) (38.0 [16.0] vs 40.0 [12.0]%) and FVC (%) (45.0 [19.0] vs 39.0 [19.0]%) in cigarette-smoke and biomass smoke exposure groups, whereas biomass smoke exposure was associated with significantly higher FEV1/FVC (75.0 [14.0] vs 58.0 [12.0]%, p=0.001), lower FVC (mL) (mean [SD] 744.0 [410.0] vs 1,063.0 [592.0] mL, p=0.035) and lower percentage of patients with FEV1/FVC 70% and more prominent loss of vital capacity than cigarette smoke exposure seems to indicate the likelihood of at least 18 years of biomass exposure to be sufficiently high to be responsible for both obstructive and restrictive pulmonary diseases. Keywords: biomass exposure, cigarette smoke, inflammatory markers, spirometry, chronic respiratory failure

Background: Use of long-term non-invasive positive pressure ventilation is increasing greatly worldwide in children with chronic respiratory failure (CRF) of all ages. This treatment requires delivery of ventilation through a non-invasive interface. Cardiac function in majority of these children is impaired. The aim of this study was to assess the effect of institution of non-invasive ventilation (NIV) on quality of life (QOL) and cardiac function in children with CRF related to neuromuscular disorders. Methods: Information obtained from all of the children under 16 years old with CRF due to neuromuscular disorders who were on NIV for at least six months and that were referred to Mofid children's hospital, Tehran, Iran between September 1, 2013, to September 1, 2017.Based on previous studies they were assessed from the year prior to starting NIV and annually thereafter. Data obtained included diagnosis, pulmonary function test, echocardiographic data, length of hospitalizations, and health care costs. Patients and parents completed questionnaires assessing QOL with NIV and recalling QOL one year before commencing NIV. All results were recorded in information forms and data were analyzed with chi square and entered in SPSS 21. Results: Follow-up ranged from 6 to 36 months (median 18). Before and after NIV hospitalization rates (P

Birsen Ocakli, Eylem Acarturk, Emine Aksoy, Sinem Gungor, Fulya Ciyiltepe, Selahattin Oztas, Ipek Ozmen, Meltem Coban Agca, Cuneyt Salturk, Nalan Adiguzel, Zuhal Karakurt Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: The aim of this study was to evaluate the impact of exposure to biomass smoke vs cigarette smoke on serum inflammatory markers and pulmonary function parameters in patients with chronic respiratory failure (CRF).Patients and methods: A total of 106 patients with CRF divided into age and gender-matched groups of cigarette-smoke exposure (n=55, mean [SD] age: 71.0 [12.0] years, 92.7% were females) and biomass smoke exposure (n=51, mean [SD] age: 73.0 [11.0] years, 94.1% were females) were included in this retrospective study. Data on patient demographics (age and gender), inflammatory markers, including neutrophil-to-lymphocyte ratio, C-reactive protein, platelet/mean platelet volume ratio, arterial blood gas analysis, and pulmonary function test findings, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were obtained from medical records.Results: Carbon dioxide partial pressure levels were significantly higher in the biomass smoke exposure than in the cigarette smoke exposure group (mean [SD] 51.0 [8.0] vs 47.0 [8.0] mmHg, p=0.026, respectively). Spirometry revealed similarly low levels for FEV1 (%) (38.0 [16.0] vs 40.0 [12.0]%) and FVC (%) (45.0 [19.0] vs 39.0 [19.0]%) in cigarette-smoke and biomass smoke exposure groups, whereas biomass smoke exposure was associated with significantly higher FEV1/FVC (75.0 [14.0] vs 58.0 [12.0]%, p=0.001), lower FVC (mL) (mean [SD] 744.0 [410.0] vs 1,063.0 [592.0] mL, p=0.035) and lower percentage of patients with FEV1/FVC 70% and more prominent loss of vital capacity than cigarette smoke exposure seems to indicate the likelihood of at least 18 years of biomass exposure to be sufficiently high to be responsible for both obstructive and restrictive pulmonary diseases. Keywords: biomass exposure, cigarette smoke, inflammatory markers, spirometry, chronic respiratory failure