Yellow nail syndrome linked to a mediastinal lipoma: a case report.

Background: Yellow nail syndrome is characterized by a yellow discoloration of the nails, respiratory symptoms, and lymphedema. It was first described in 1964 and has an estimated prevalence of less than 1:1.000.

[Task Force Dyspnoe unit (DU)].

Acute dyspnoea is one of the most common internal medicine symptoms in the emergency department. It arises from an acute illness or from the exacerbation of a chronic illness. Symptom-related emergency structures and corresponding structural guidelines already exist in the stroke and chest pain units for dealing with the leading symptoms of acute stroke and acute chest pain.

[Technical aspects and innovations in non-invasive and invasive ventilation].

Non-invasive and invasive ventilation have become essential for therapy in acute and chronic respiratory failure. More than one-third of patients in intensive care units receive invasive ventilation, and the number of ventilated patients in out-of-hospital care is also steadily increasing. While normalization of blood gases was considered the most significant goal in past decades, and the idea that mechanical ventilation also poses dangers played little role, the dominant thought at present is the application of ventilation from the most protective point of view possible.

[Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine].

The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions.

Hypoxic, anemic and cardiac hypoxemia: When does tissue hypoxia begin?

In case of hypoxemia, the oxygen content is often still in the lower normal range, so that there is no hypoxia in the tissue. If the hypoxia-threshold is reached in the tissue in hypoxic, anemic and also cardiac-related hypoxemia, identical counterregulations occur in the cell metabolism, regardless of the cause of hypoxemia. In clinical practice, this pathophysiologic fact is sometimes ignored, although depending on the cause of hypoxemia, assessment and therapy vary widely.

[Interdisciplinary Perspectives on the Role of Aerosol Transmission in SARS-CoV-2 Infections].

The relevance of aerosols for the transmission of the Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2) is still debated. However, over time, in addition to distancing and hygiene rules, aerosol physics-based measures such as wearing face masks and ventilating indoor spaces were found to be efficient in reducing infections. In an interdisciplinary workshop "Aerosol & SARS-CoV-2" of the Association for Aerosol Research (GAeF) in cooperation with the German Society for Pneumology and Respiratory Medicine (DGP), the Professional Association of General Air Technology of the VDMA, the German Society for Virology (GfV), the Health Technology Society (GG) and the International Society for Aerosols in Medicine (ISAM) under the auspices of the Robert Koch Institute (RKI) in March 2021, the need for research and coordination on this topic was addressed.

Hemoglobin Rothschild - Unimpaired physical performance and oxygen uptake - A case report with literature review.

Asymptomatic patients with hemoglobin (Hb) variants can be detected by low oxygen levels in pulse oximetry (SpO₂). Depending on the type of Hb variant, low SpO₂ values are either falsely low, with corresponding normal arterial oxygen saturation (SaO₂), or truly low, with low SaO₂ values, as observed in Hb variants with low oxygen binding affinity. In this context, attention must be paid to the method of determining SaO₂.

Influence of wearing masks on exhaled air aerodynamics.

Since aerosol inhalation is the most common mechanism for COVID-19 infection, the respiratory protective devices (RPDs) have the highest importance in personal protection. The aim of this study was to assess the efficiency of 10 different RPDs in shortening the travelling distance of exhaled air by range measurement using the schlieren imaging technique. When a RPD is worn by a person resting in a seated position, the expired air does not exceed the human convective boundary layer (CBL).

Randomized Clinical Study of Temporary Transvenous Phrenic Nerve Stimulation in Difficult-to-Wean Patients.

Diaphragm dysfunction is frequently observed in critically ill patients with difficult weaning from mechanical ventilation. To evaluate the effects of temporary transvenous diaphragm neurostimulation on weaning outcome and maximal inspiratory pressure. Multicenter, open-label, randomized, controlled study.

Conservative management of COVID-19 associated hypoxaemia.

https://bit.ly/3hwPLCL.

Exhalation Spreading During Nasal High-Flow Therapy at Different Flow Rates.

Objectives: Severe acute respiratory syndrome coronavirus 2 is transmitted through aerosols and droplets. Nasal high-flow therapy could possibly increase the spreading of exhalates from patients. The aim of this study is to investigate whether nasal high-flow therapy affects the range of the expiratory plume compared with spontaneous breathing.

[Early Pulmonary Rehabilitation after Long Term Mechanical Ventilation].

Background:  The term early rehabilitation is defined as a rehabilitation that begins in the early phase after acute illness and is statutory positioned in § 39SGB V. Aim of this investigation is to describe the quality of outcome of pulmonary early rehabilitation.

Method:  Prospective census of functional parameters, status of ventilation and discharge-disposition in a specialized unit for early pulmonary rehabilitation over a period of one year.

Conservative management of COVID-19 associated hypoxaemia.

https://bit.ly/3csrpWO.

Conservative management of COVID-19 associated hypoxaemia.

Background: Invasive mechanical ventilation of hypoxaemic coronavirus disease 2019 (COVID-19) patients is associated with mortality rates of >50%. We evaluated clinical outcome data of two hospitals that agreed on a predefined protocol for restrictive use of invasive ventilation where the decision to intubate was based on the clinical presentation and oxygen content rather than on the degree of hypoxaemia.

Method: Data analysis was carried out of patients with positive PCR-testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), typical history, and symptoms and pulmonary infiltrates who exhibited oxygen saturation values of <93%.

[Statement of the German Society for Pulmonology and Respiratory Medicine Regarding the Regulation to Use FFP and Surgical Masks in the General Population].

On January 19, 2021, a new regulation on the mask requirement was issued in an initiative by the federal and state governments. This regulation obliges citizens to wear medical masks on public transport and in shops. In its statement, the German Society for Pneumology and Respiratory Medicine (DGP) describes the technical background of the various medical masks and explains their functionality using the associated standards.

The Feasibility of High-Intensity Interval Training in Patients with Intensive Care Unit-Acquired Weakness Syndrome Following Long-Term Invasive Ventilation.

Background: Intensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation. Despite recommendations of early patient mobilisation, little is known about the feasibility, safety and benefit of interval training in early rehabilitation facilities (ERF) after long-term invasive ventilation.

Methods And Results: We retrospectively analysed two established training protocols of bicycle ergometry in ERF patients after long-term (> 7 days) invasive ventilation (n = 46).

[Investigation of the Filter Performance in a Sample of Standardised Particle-filtering Half Masks].

Background:  Thanks to a simplified special approval process that was valid until October 1st, 2020, a large number of particle-filtering half masks have come onto the German market. When caring for SARS-CoV-2 infected patients, the RKI recommends wearing particle-filtering half masks with a filter performance of at least 94 %, which corresponds to FFP class 2 according to EN 149:2001+A1:2009. We have examined 15 particle-filtering half masks with different specifications for their filter performance METHOD:  The masks were clamped in a jig in an airtight test box.

Bench testing of noninvasive ventilation masks with viral filters for the protection from inhalation of infectious respirable particles.

During the beginning of the SARS-CoV-2 pandemic, there was a shortage of masks and respirators for the protection of health care professionals. Masks for noninvasive ventilation (NIV) in combination with viral-proof filters, worn by healthcare workers, could serve as an alternative protection measure. We determined the simulated protection factor (SPF) of such devices in comparison to conventional surgical masks, N95, and FFP3 respirators.

[Weaning in a Pandemic Situation - A Position Paper].

The logistical and infectious peculiarities and requirements challenge the intensive care treatment teams aiming at a successful liberation of patients from long-term mechanical ventilation. Especially in the pandemic, it is therefore important to use all potentials for weaning and decannulation, respectively, in patients with prolonged weaning.Weaning centers represent units of intensive medical care with a particular specialization in prolonged weaning.

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society.

Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by respiratory muscle insufficiency and/or lung parenchymal disease; that is, when other treatments such as medication, oxygen administration, secretion management, continuous positive airway pressure (CPAP), or nasal high-flow therapy have failed. MV is required for maintaining gas exchange and allows more time to curatively treat the underlying cause of respiratory failure.

Normal and obstructive breathing physiology during sleep.

Purpose: To estimate the severity of flow limitation in patients with OSA, the number of breaths with flattened inspiratory flow curves should be identified. Attempts to do a quantitative analysis of the flattening degree for all breaths in a nighttime recording have failed up to now.

Methods: SOMNOmedics (Randersacker, Germany) developed an automated flattening analysis parameter called the obstructive coefficient (OC).

Community Masks During the SARS-CoV-2 Pandemic: Filtration Efficacy and Air Resistance.

Many countries have introduced a compulsory use of community masks for certain public areas during the SARS-CoV-2 pandemic. Different manufacturers offer reusable community masks in large quantities. The efficacy of these masks, however, is unknown.