[Cerebral arterial air embolism: the effect of hyperbaric oxygen therapy]. / Cerebrale arteriële luchtembolie.

BACKGROUND: Iatrogenic gas embolism is the presence of gas in vascular structures. Feared are those in coronary or cerebral arteries. These can result in cerebral or myocardial infarction. CASE DESCRIPTION: A 79-year-old female underwent CT-guided biopsy of the lung. Minutes later she developed neurological symptoms. After administration of oxygen her symptoms initially improved, but later worsened. Based on her symptoms air embolism was suspected. She recovered fully after treatment with hyperbaric oxygen. CONCLUSION: Air embolism is a potentially life-threatening complication of surgical, radiological or vascular interventions. Early recognition can lead to prompt treatment and better prognosis. If air embolism is suspected the patient should be treated according to ABCDE principles and oxygen should be administered. In case of neurological or circulatory symptoms a hospital that could provide hyperbaric oxygen therapy should be contacted as soon as possible.

Do-not-intubate status and COVID-19 mortality in patients admitted to Dutch non-ICU wards.

Mortality from COVID-19 has been particularly high in elderly patients on mechanical ventilation. Treatment outcomes for patients with do-not-intubate (DNI) status are unknown. One hundred patients admitted to the non-ICU ward during the "first wave" were retrospectively analyzed. Mortality rate was 49% in patients with a DNI order. This subgroup was characterized by significantly higher age, more comorbidity, and care dependency. Mortality among DNI patients was three times higher than other patients, but not higher than some of the published mortality rates for elderly mechanically ventilated patients. Advanced care planning is essential in COVID-19 to assist patient autonomy and prevent non-beneficial medical interventions.

Fatigue mediates the relationship between physical fitness and quality of life in cancer survivors.

OBJECTIVES: This study aims to investigate whether fatigue mediates the association between physical fitness and quality of life. DESIGN: Uncontrolled pre-post intervention design. METHODS: Pre- and post-intervention measurements were conducted in 119 patients who completed chemotherapy treatment for various types of cancer. The intervention was an 18-week exercise programme consisting of high-intensity resistance and interval training. We assessed physical fitness - peak oxygen uptake and peak power output - self-reported fatigue (Multidimensional Fatigue Inventory - subscales general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue-, and fatigue symptom scale of EORTC QLQ-C30) and quality of life (EORTC QLQ-C30, subscale global quality of life). Linear regression analyses were conducted on the residual change scores of the variables. The mediated effect of fatigue on the association between physical fitness and quality of life was examined using the products of coefficient method. Bootstrapping was used to calculate the confidence intervals. RESULTS: We found significant associations between changes in physical fitness and global quality of life, between physical fitness and fatigue, and between fatigue and global quality of life. General fatigue mediated the positive association between peak power output and global quality of life, accounting for 82% of the total association. Physical fatigue, reduced activity, reduced motivation, and fatigue symptom were also mediators of this association. The mediation effects accounted for 91%, 76%, 38% and 71% of the total association, respectively. Reduced activity and reduced motivation mediated the association between peak oxygen uptake and global quality of life. Multiple mediation analyses showed that physical aspects of fatigue were stronger mediators than mental aspects. CONCLUSIONS: General fatigue and physical aspects of fatigue mediate the relationship between physical fitness and quality of life in cancer survivors. We found no mediating effect of mental fatigue.

Can peak work rate predict peak oxygen uptake in children with juvenile idiopathic arthritis?

OBJECTIVE: To examine whether peak work rate (W(peak)) can predict peak oxygen uptake (VO(2peak)) in children with juvenile idiopathic arthritis (JIA). METHODS: Ninety-one patients with JIA with a mean +/- SD age of 11.4 +/- 2.9 years underwent a cardiopulmonary exercise test in which VO(2peak) and W(peak) were determined. A multivariate regression model was used to formulate a regression equation to predict VO(2peak) using W(peak) and anthropometric and demographic details. This regression equation was subsequently cross-validated using an unrelated data set from children with JIA (n = 17). RESULTS: The following linear regression equation to predict VO(2peak) was established: VO(2peak) (liters/minute) = 0.308 + 0.146 x sex (0 = female, 1 = male) + 0.005 x weight (kg) + 0.008 x W(peak) (W) (R(2) = 0.91, standard error of the estimate = 0.18 liter/minute). Using this equation, the predicted VO(2peak) was strongly related to the measured VO(2peak) (r = 0.96, P < 0.0001). Bland and Altman analysis revealed a mean difference of 0.01 liter/minute and limits of agreement between -0.35 and 0.35 liter/minute. CONCLUSION: This study suggests that W(peak) is a strong predictor of VO(2peak) in children with JIA and may be used as a surrogate measure of VO(2peak) in situations where it is not possible to formally assess VO(2peak).

High-intensity strength training improves quality of life in cancer survivors.

INTRODUCTION: Cancer rehabilitation programs mainly involve endurance training, and little attention is paid to strength training. Cancer survivors are generally advised to train at much lower workloads than the standard guidelines for strength training suggest. The purpose of this study is to evaluate the effectiveness of an 18-week high-intensity strength training program in cancer survivors. METHODS: Fifty-seven patients (age 24 to 73 years) who had received chemotherapy for lymphomas, breast, gynecologic, testicular, or colorectal cancer completed the program. Outcome measures were changes in muscular strength (one-repetition maximum), cardiopulmonary function (VO2 max), maximal short exercise capacity (MSEC), body composition and health-related quality of life (HRQOL) between baseline and follow-up. DISCUSSION: The high-intensity strength training was well tolerated by all patients. Significant improvements in muscle strength were found, with effect sizes varying from 1.32 to 2.68. VO2 max increased significantly by 10% in men and by 13% in women. Different functional scales of HRQOL improved (p < 0.01), with effect sizes varying from 0.47 to 0.82. Muscle strength correlated significantly with physical functioning before and after the training program. CONCLUSION: We conclude that a supervised, high-intensity strength training program seems to be an effective means to improve muscle strength, cardiopulmonary function, and HRQOL and should be incorporated in cancer rehabilitation programs. Further randomized trials are needed to confirm the results.

Exercise testing and training in a cancer rehabilitation program: the advantage of the steep ramp test.

OBJECTIVE: To compare the short maximal exercise capacity test (steep ramp test) with the submaximal test to determine the most appropriate exercise test in cancer rehabilitation. DESIGN: A prospective study in which a submaximal test, a maximal short exercise capacity test (steep ramp test), and a maximal oxygen consumption test (Vo(2)max test) were performed before and after an 18-week training program. Vo(2)max testing, the criterion standard for the measurement of physical capacity, was compared with the submaximal test and the steep ramp test. SETTING: Community hospital and physiotherapy. PARTICIPANTS: Thirty-seven cancer survivors (10 men, 27 women) treated with chemotherapy. The subjects' mean age +/- standard deviation (SD) was 48+/-11 years. INTERVENTION: An 18-week training program including strength training, interval aerobic training, and home-based activities (endurance). MAIN OUTCOME MEASURES: Estimated Vo(2)max (submaximal test) and maximal workload (steep ramp test) were assessed during the exercise tests and compared with the results of the Vo(2)max test. RESULTS: A paired t test showed a significant improvement in Vo(2)max (+13%, P<.001) and maximal workload (+19%, P<.001) after the training program. This improvement was confirmed in the steep ramp test (maximal workload, +13%, P<.001) but not in the submaximal test (estimated Vo(2)max, +4%, P=.192). Pearson correlation quantified only a moderate correlation between the Vo(2)max test and the submaximal test and a high correlation between the Vo(2)max test and the steep ramp test. Intraclass correlation determined the test-retest reliability of the submaximal test (.873) and the steep ramp test (.996). A linear regression model (Vo(2)max, 6.7; steep ramp Wmax, +356.7) was estimated to predict Vo(2)max from the steep ramp test outcome, implying a prediction margin of +/-2 SDs (616 mL/min). CONCLUSIONS: The submaximal test proved to be invalid, whereas the steep ramp test seems to be a practicable, reliable, and valid test for the assessment of the training dose. The steep ramp test can be regularly repeated during the training program, providing information needed to readjust the training dose according to the progress made.