Nocturnal non-invasive positive pressure ventilation for COPD.

There is an ongoing discussion on whether long-term non-invasive positive pressure ventilation (NPPV) should be used in chronic hypercapnic chronic obstructive pulmonary disease (COPD) patients. Early trials had failed to show convincing physiological and clinical effects using NPPV with assisted modes of ventilation and rather low inflation pressures. In particular, long-term survival could not be improved and findings on health-related quality of life had been conflicting.

Invasive home mechanical ventilation: living conditions and health-related quality of life.

Background: The number of patients with invasive home mechanical ventilation (HMV) following unsuccessful weaning is steadily increasing, but little is known about the living conditions and health-related quality of life (HRQL) in these patients.

Objectives: To establish detailed information on living conditions and HRQL in patients with invasive HMV.

Methods: The Severe Respiratory Insufficiency Questionnaire (SRI) was used to measure specific HRQL aspects in addition to patient interviews on individual living conditions during home visits.

Spot check analysis of gas exchange: invasive versus noninvasive methods.

Background: Correct measurement of PO₂ and PCO₂ is essential to establish appropriate therapy such as long-term oxygen therapy (LTOT) in patients suffering from respiratory failure.

Objectives: We aimed to compare common invasive and noninvasive methods for assessing blood gas components for spot check analysis.

Methods: Arterial (PaO₂, PaCO₂) and capillary blood gas (PCBGO2, PCBGCO2) measurements were taken consecutively in a randomized order and were compared with noninvasive measurements obtained from the transcutaneous monitoring of PO₂ and PCO₂ (PtcOv, PtcCO₂, sensor-temperature 44°C).

[Unilateral agenesis of pulmonal artery in adults: a rare disease frequently undiagnosed].

Introduction: Unilateral absence of a pulmonary artery (UAPA) in adults without any other cardiovascular anomalies is a very rare clinical entity. Usually UAPA in adults remains undetected because of the symptom-free clinical course. The most common symptoms are hemoptysis and recurrent pulmonary infections.

Intermittent noninvasive ventilation at San José Hospital in Chile: report of a German donation.

Home mechanical ventilation is currently expanding in Chile, but its application along the country is hindered by financial and geographical reasons. In 2006 the San José Hospital in Santiago de Chile developed a non-invasive ventilation (NIV) center as a strategy to overcome the limitations of ventilator availability from public resources. Since then, this center provides intermittent diurnal sessions of NIV to patients with chronic hypercapnic respiratory failure.

Unilateral Lobe Resection by Video-Assisted Thoracoscopy Leads to the Most Optimal Functional Improvement in Severe Emphysema.

Background Lung volume reduction surgery (LVRS) is a well-established treatment option for pulmonary emphysema, but the most advantageous technical approach remains debatable. Methods Short- and long-term outcomes were comparably assessed in pulmonary emphysema patients who underwent unilateral LVRS with either lobe or sublobe (segment or wedge) resection. Patients were consecutively enrolled in the study after careful conventional and computer-based definition of the target region.

[Prophylaxis and therapy for atrial fibrillation after general thoracic surgery].

Following thoracic surgery atrial fibrillation (AF) frequently occurs in 12 to 44 % of cases postoperatively and is related to an increased morbidity and mortality. In 2011, the Society of Thoracic Surgeons of the United States published guidelines for the prophylaxis and treatment of postoperative AF. High evidence levels are provided for continuing β-blocker treatment despite its known negative inotropic effects.

Impact of intelligent volume-assured pressure support on sleep quality in stable hypercapnic chronic obstructive pulmonary disease patients: a randomized, crossover study.

Background: Noninvasive positive-pressure ventilation (NPPV) using intelligent volume-assured pressure support (iVAPS) combines volume- and pressure-preset NPPV and therefore uses a variation of inspiratory positive airway pressures.

Objectives: The effect of iVAPS on sleep quality in stable hypercapnic patients with chronic obstructive pulmonary disease (COPD) has not been determined.

Methods: In this randomized, open-label, two-treatment, two-period, crossover study, patients were randomized to receive high-intensity (HI)-NPPV and then iVAPS or iVAPS and then HI-NPPV.

Home mechanical ventilation for COPD: high-intensity versus target volume noninvasive ventilation.

Background: High-intensity noninvasive ventilation (HI-NIV) is the most effective means of improving several physiological and clinical parameters in subjects with chronic hypercapnic COPD. Whether the newer hybrid mode using target tidal volume noninvasive ventilation (target V(T) NIV) provides additional benefits remains unclear.

Methods: Subjects with COPD successfully established on long-term HI-NIV were switched to target V(T) NIV.

Gender-specific effects of a phytogenic feed additive on performance, intestinal physiology and morphology in broiler chickens.

To date, most studies published were carried out on broilers of the same sex, and possible gender-specific effects of phytogenic substances have not been investigated so far. A 3 × 2 factorial study was performed to examine gender-specific effects of a PFA at two dietary levels (150, 1500 ppm) on growth performance, carcass traits and gastrointestinal attributes in broiler chickens versus an untreated control group. The addition of 150 ppm of the PFA led to a downregulation of trypsinogen mRNA in pancreas compared with the control group (p < 0.

Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial.

Background: Evidence is weak for the ability of long-term non-invasive positive pressure ventilation (NPPV) to improve survival in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). Previous prospective studies did not target a reduction in hypercapnia when adjusting ventilator settings. This study investigated the effect of long-term NPPV, targeted to markedly reduce hypercapnia, on survival in patients with advanced, stable hypercapnic COPD.

Transamination governs nitrogen isotope heterogeneity of amino acids in rats.

The nitrogen isotope composition (δ¹⁵N) of different amino acids carries different dietary information. We hypothesized that transamination and de novo synthesis create three groups that largely explain their dietary information. Rats were fed with ¹⁵N-labeled amino acids.

Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations.

Introduction: While non-invasive ventilation aimed at avoiding intubation has become the modality of choice to treat mild to moderate acute respiratory acidosis, many severely acidotic patients (pH <7.20) still need intubation. Extracorporeal veno-venous CO2 removal (ECCO2R) could prove to be an alternative.

[Recommendations for respiratory muscle testing].

Based on the tremendous impact of impaired respiratory muscle function, tests on their function play a significant role in respiratory and intensive care medicine. Besides differential diagnosing e.g.

Techniques for the measurement and monitoring of carbon dioxide in the blood.

The relationship between an elevated partial pressure of carbon dioxide (Pco2) and reduced alveolar ventilation resulting from respiratory failure primarily affecting the respiratory pump was first reported during the 1952 Copenhagen polio epidemic. Several methods for Pco2 estimation, such as blood gas analyses, capnography, and transcutaneous Pco2 measurements, have since been developed to assess alveolar ventilation. The clinical setting in which CO2 measurement is valuable includes acute and chronic respiratory failure, transport, cardiopulmonary resuscitation, patient-controlled analgesia, and procedural sedation.

Development of an experimental model to assess the bioavailability of zinc in practical piglet diets.

Sufficient zinc (Zn) supply is a key element of successful animal husbandry. Proper use of dietary Zn sources, however, demands knowledge of Zn requirement and bioavailability, reflecting practical feeding systems. In this study, an experimental model is presented where 48 fully weaned and individually housed piglets received a fine differentiated alimentary Zn supply.

[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 insufficiency of the respiratory muscles and/or lung parenchymal disease when/after other treatments, i. e.

The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension.

Purpose: Increased dyspnea and reduced exercise capacity in pulmonary arterial hypertension (PAH) can be partly attributed to impaired respiratory muscle function. This prospective study was designed to assess the impact of exercise and respiratory training on respiratory muscle strength and 6-min walking distance (6MWD) in PAH patients.

Methods: Patients with invasively confirmed PAH underwent 3 weeks of in-hospital exercise and respiratory training, which was continued at home for another 12 weeks.

[Weaning from mechanical ventilation: the pneumologist's perspective].

Weaning from mechanical ventilation plays a key-role in modern intensive care medicine: about 40% of all ventilated patients suffer from difficult/prolonged weaning causing about 50% of the total stay on the intensive care unit (ICU). Severe chronic airway, lung and thoracic disorders, neuromuscular diseases and morbid obesity cause respiratory muscle insufficiency and result in respiratory failure with prolonged weaning. In Germany, pneumologists have a wide ranging expertise with this patient cohort and established weaning centers over the past 25 years.

Minute ventilation during spontaneous breathing, high-intensity noninvasive positive pressure ventilation and intelligent volume assured pressure support in hypercapnic COPD.

Background: High-intensity noninvasive positive pressure ventilation (HI-NPPV) is an effective treatment option in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). However, the effect of HI-NPPV compared with spontaneous breathing (SB) on minute ventilation (MV) in patients receiving long-term treatment remains to be determined. This study compared MV during HI-NPPV and SB.

[Understanding ventilator-induced diaphragmatic dysfunction (VIDD): progress and advances].

There is rising evidence that ventilator-induced diaphragmatic dysfunction (VIDD) is not just an artifactual finding from animal studies, but actually occurs in humans undergoing invasive mechanical ventilation. Initial research findings in humans have demonstrated that periods of controlled invasive mechanical ventilation lasting just 18 - 69 hours can lead to a marked reduction in diaphragmatic myofibers. More recently, it has been shown that even short periods (e.

Detection of HBoV DNA in idiopathic lung fibrosis, Cologne, Germany.

We report two confirmed cases of usual interstitial pneumonia (UIP) associated with infection of the human bocavirus (HBoV). In one case HBoV was identified in the bronchoalveolar lavage (BAL) during an acute exacerbation as well as post mortem in different tissues giving raise to the hypothesis that HBoV infections trigger UIP or could be a causative agent and be a systemic component in UIP. In the other case, the UIP was confirmed by radiological methods and HBoV was detected in the BAL during an acute exacerbation.