Iatrogenic infection associated with positive airway pressure therapy: A review of precedent, epidemiology, bioaerosols and risk mitigation.

Currently, evidence-based guidelines about cleaning positive airway pressure devices for maintenance or reprocessing for a new user do not exist. There is no strong evidence of harm caused by contaminated positive airway pressure equipment. Future research opportunities exist to streamline cleaning processes, assure hygiene, and reduce waste.

The Role of High Flow Nasal Therapy in Chronic Respiratory Failure.

High-flow nasal therapy (HFNT) has an increasing role in the management of acute hypoxic respiratory failure. Due to its tolerable interface and ease of use, its role in chronic hypercapnic respiratory failure (CHRF) is emerging. This article examines the literature to date surrounding the short and long-term mechanisms of HFNT in sleep and wakefulness of CHRF patients.

Hypercapnia is not excluded by normoxia in neuromuscular disease patients: implications for oximetry.

Background: Pulse oximetry is widely used in the assessment of chronic respiratory failure in neuromuscular disease (NMD) patients. Chronic respiratory failure is the major cause of morbidity and mortality, necessitating early diagnosis and intervention. Guidelines suggest that an arterial blood gas (ABG) measurement is indicated if oxygen saturation ( ) is ≤94% in the absence of lung disease.

Online Education Improves Confidence in Mechanical Insufflation-Exsufflation.

Background: Mechanical insufflation-exsufflation (MI-E) is a cough augmentation technique used to support people with an ineffective cough. MI-E can be complex due to the number of different pressure, flow, and temporal setting adjustments needed to optimize cough efficacy. Many clinicians identify inadequate training, limited experience, and low confidence as barriers to MI-E use.

Perceptions of Noninvasive Ventilation During Exercise in Noninvasive Ventilation-Naïve Patients With COPD.

Background: The perceptions of using noninvasive ventilation (NIV) during exercise in patients with COPD who are naïve to NIV is unknown. The present study aimed to examine the perceptions of using NIV during exercise in people with COPD and to determine the relationship between patient perceptions with both baseline patient characteristics and exercise outcomes.

Methods: During a trial examining the effect of NIV during exercise on dynamic hyperinflation in people with COPD who were naïve to NIV, participants completed a 5-point Likert scale questionnaire (scored strongly disagree -2 to strongly agree +2) before and after using NIV during exercise and a semi-structured interview after using NIV during exercise.

Cardiopulmonary coupling and serum cardiac biomarkers in obesity hypoventilation syndrome and obstructive sleep apnea with morbid obesity.

Study Objectives: The main cause of death in patients with obesity hypoventilation syndrome (OHS) is cardiac rather than respiratory failure. Here, we investigated autonomic-respiratory coupling and serum cardiac biomarkers in patients with OHS and obstructive sleep apnea (OSA) with comparable body mass index and apnea-hypopnea index.

Methods: Cardiopulmonary coupling (CPC) and cyclic variation of heart rate analysis was performed on the electrocardiogram signal from the overnight polysomnogram.

Bilevel Noninvasive Ventilation During Exercise Reduces Dynamic Hyperinflation and Improves Cycle Endurance Time in Severe to Very Severe COPD.

Background: During exercise, dynamic hyperinflation (DH), measured by a reduction in inspiratory capacity (IC), increases exertional dyspnea and reduces functional capacity in many patients with severe COPD. Although noninvasive ventilation (NIV) during exercise can improve exercise duration, the effect on DH is unclear.

Research Questions: In people with COPD, resting hyperinflation, and evidence of DH during exercise, does bilevel NIV during exercise reduce DH and increase endurance time compared with exercise with no NIV, and does NIV with an individually titrated expiratory positive airway pressure (T-EPAP) reduce DH and increase exercise endurance time more than NIV with standardized EPAP (S-EPAP) of 5 cm HO?

Study Design And Methods: A randomized crossover trial in which investigators and participants were blinded between NIV interventions was performed.

Pandemics, epidemics, viruses, plagues, and disease: Comparative frequency analysis of a cultural pathology reflected in science fiction magazines from 1926 to 2015.

Science fiction includes many dystopian narratives, often featuring epidemics, pandemics, plagues, viruses, and disease. As science fiction has grown in popularity and prevalence it appeals to an increasingly broad demographic, is employed in research communication and education, and as a genre it is frequently argued that it reflects contemporary cultural interests and concerns. To identify the relevance of science fiction as an indicator of popular trends relating to the pathologies of disease, a word frequency comparison of selected key words found in the Google Books 2012 English Corpus has been made to a representative corpus of science fiction magazines dating between 1926 and 2015.

Effect of non-invasive ventilation on the measurement of ventilatory and metabolic variables.

The effect of non-invasive ventilation (NIV) on the accuracy of measurements of ventilation, oxygen consumption (V˙O2) and carbon dioxide production (V˙CO2) was examined using a simulator. Known gas volumes of oxygen and carbon dioxide were delivered to a metabolic system that measured tidal volume, respiratory rate, V˙O2 and V˙CO2, both with and without NIV. Bland-Altman analyses were used to compare between conditions.

Non-invasive ventilation during exercise training for people with chronic obstructive pulmonary disease.

Background: Exercise training as a component of pulmonary rehabilitation improves health-related quality of life (HRQL) and exercise capacity in people with chronic obstructive pulmonary disease (COPD). However, some individuals may have difficulty performing exercise at an adequate intensity. Non-invasive ventilation (NIV) during exercise improves exercise capacity and dyspnoea during a single exercise session.

Validation of respiratory inductive plethysmography (LifeShirt) in obesity hypoventilation syndrome.

Validation of respiratory inductive plethysmography (LifeShirt system) (RIPLS) for tidal volume (VT), minute ventilation (V˙E), and respiratory frequency (fB) was performed among people with untreated obesity hypoventilation syndrome (OHS) and controls. Measures were obtained simultaneously from RIPLS and a spirometer during two tests, and compared using Bland Altman analysis. Among 13 OHS participants (162 paired measures), RIPLS-spirometer agreement was unacceptable for VT: mean difference (MD) 3 mL (1%); limits of agreement (LOA) -216 to 220 mL (±36%); V˙E MD 0.

Moderate concentrations of supplemental oxygen worsen hypercapnia in obesity hypoventilation syndrome: a randomised crossover study.

Introduction: In people with obesity hypoventilation syndrome (OHS), breathing 100% oxygen increases carbon dioxide (PCO2), but its effect on pH is unknown. This study investigated the effects of moderate concentrations of supplemental oxygen on PCO2, pH, minute ventilation (VE) and physiological dead space to tidal volume ratio (VD/VT) among people with stable untreated OHS, with comparison to healthy controls.

Methods: In a double-blind randomised crossover study, participants breathed oxygen concentrations (FiO2) 0.

Validity of arterialised-venous P CO2, pH and bicarbonate in obesity hypoventilation syndrome.

This prospective study investigated the validity of arterialised-venous blood gases (AVBG) for estimating arterial carbon dioxide P CO2, pH and bicarbonate (HCO3(-)) in people with obesity hypoventilation syndrome (OHS). AVBGs were obtained from an upper limb vein, after heating the skin at 42-46°C. Arterial blood gas (ABG) and AVBG samples were taken simultaneously and compared using Bland Altman analysis.

High- and low-level pressure support during walking in people with severe kyphoscoliosis.

To determine whether the level of pressure support (PS) provided during exercise influences endurance time in people with severe kyphoscoliosis, a double-blind randomised crossover study was performed. We hypothesised that high-level PS would be required to enhance endurance time in this population with high impedance to inflation. 13 participants with severe kyphoscoliosis performed four endurance treadmill tests in random order: unassisted; with sham PS; low-level PS of 10 cmH(2)O (PS 10); and high-level PS of 20 cmH(2)O (PS 20).

Clinical commentary: obstetric and respiratory management of pregnancy with severe spinal muscular atrophy.

We present a combined obstetric and respiratory perspective on two pregnancies for a woman with severe Type 2 Spinal Muscular Atrophy (SMA). Our patient had the lowest prepregnancy weight (20 kg) and vital capacity of 0.34 L (VC 11% predicted) yet to be reported in the sparse literature on pregnancy with SMA.

Bilevel ventilation during exercise in acute on chronic respiratory failure: a preliminary study.

To determine the immediate effects of bilevel non-invasive ventilation plus oxygen (NIV+O(2)) during exercise compared to exercise with O(2) alone in people recovering from acute on chronic hypercapnic respiratory failure (HRF), a randomised crossover study with repeated measures was performed. Eighteen participants performed six minute walk tests (6MWT) and 16 participants performed unsupported arm exercise (UAE) tests with NIV+O(2) and with O(2) alone in random order. Distance walked increased by a mean of 43.

Non-invasive ventilation during arm exercise and ground walking in patients with chronic hypercapnic respiratory failure.

Background And Objective: People with chronic hypercapnic respiratory failure (HRF) often have a ventilatory limitation to exercise with difficulty performing activities of daily living. Although non-invasive ventilation (NIV) appears to reduce the ventilatory limitation and improve exercise performance in people with severe COPD, the effect of NIV during functional activities such as unsupported arm exercise (UAE) and ground walking in people with chronic HRF is unclear.

Methods: Seventeen patients with chronic HRF (PaCO(2) 52.

Reliability of two goniometric methods of measuring active inversion and eversion range of motion at the ankle.

Background: Active inversion and eversion ankle range of motion (ROM) is widely used to evaluate treatment effect, however the error associated with the available measurement protocols is unknown. This study aimed to establish the reliability of goniometry as used in clinical practice.

Methods: 30 subjects (60 ankles) with a wide variety of ankle conditions participated in this study.