ABSTRACT
OBJECTIVE: To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). METHODS: This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. RESULTS: CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. CONCLUSION: CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. TRIAL REGISTRATION: ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www. CLINICALTRIALS: gov/study/NCT02117908 CRITICAL RELEVANCE STATEMENT: This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. KEY POINTS: No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia.
ABSTRACT
BACKGROUND: One of the main features of COVID-19 pneumonia is hypoxemic acute respiratory failure (ARF), often requiring ventilatory support. The influence of chest physiotherapy in patients with ARF is not extensively studied. The aim of the study was to analyze the short-time effects of chest physiotherapy using a 10 cm H2O threshold valve in patients with COVID-19 and ARF. Methods; Quasi-experimental cross-sectional study, in hospitalized patients from March to May 2020. The fractions of inspired oxygen, oxygen saturation, heart rate, respiratory rate and dyspnea were collected before and after the starting session (day 1) and after the 5th day of therapy. RESULTS: The final sample size included 125 patients. Significant differences (p < 0.01) were found in the pre-post intervention SpO2/FiO2 ratio (250 ± 88.4 vs. 275.6 ± 97.5, p < 0.001), reaching 354.4 ± 110.2 after 5 days of therapy (p < 0.001 with respect to the baseline). The respiratory and heart rate dyspnea level did not change during the intervention. In patients needing FiO2 > 0.4, the SpO2/FiO2 ratio improvement was higher than in patients with milder severity (46.85 ± 77.69, p < 0.01). CONCLUSIONS: Chest physiotherapy with a 10 cm H2O threshold valve seems to be a safe and tolerated intervention with short-term improvement in oxygenation in patients with COVID-19 pneumonia.
ABSTRACT
Introduction: The aim of this study was to assess several air-pressure settings for MI-E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40cmH2O) in patients with neuromuscular disorders (NMD). Methods: Adults with NMD in whom MI-E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40cmH2O or maximum tolerated), and then 4 adding expiratory pressures (-10, -20, -30 and -40cm H2O or maximum tolerated) with maximum inspiratory pressure previously achieved. Results: Twenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (± 40 cmH2O) were lower than the scored in the individualized steps of the titration protocol (197.7 ± 67l/min vs 214.2 ± 60 l/min, p < 0.05). Regarding subgroups, mean PCFmax values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6 ± 80 vs 189 ± 66l/min, p < 0.05). Conclusion: The PCFmax obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI-E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures
Introducción: El objetivo del estudio fue evaluar varios ajustes de presión para insuflación-exuflación mecánica (IEM) para determinar su efecto sobre el flujo pico de tos (FPT), y comparar las mejores presiones con aquellas que son habitualmente utilizadas en la literatura (± 40 cmH2O) en pacientes con enfermedades neuromusculares (ENM). Métodos: Se reclutaron adultos con ENM en los que se indicó IEM. Se midió el FPT asistido mediante un neumotacógrafo externo, y se registraron las curvas de presión y flujo/tiempo. El protocolo incluía 9 medidas de FPT por paciente: una basal (no asistida), 4 con presiones inspiratorias crecientes sin presión negativa (10, 20, 30 y 40 cmH2O o máximo tolerado), y luego 4 presiones espiratorias (-10, -20, -30, -40 cmH2O o máxima tolerada) con la presión inspiratoria máxima conseguida. Resultados: Se incluyeron 21 pacientes, 61% con esclerosis lateral amiotrófica (ELA). Las altas presiones (>±35 cmH2O) lograron el mejor FPT solo en el 50% de los sujetos. Los FPT medios con presiones recomendadas de ± 40 cmH2O (197,7 ± 67 l/min) fueron más bajos que los conseguidos con presiones de titulación individualizadas con el protocolo (214,2 ± 60 l/min, p < 0,05). Con respecto a los subgrupos, los valores medios de FPT máximos en los pacientes con ELA con síntomas bulbares fueron significativamente mayores que los logrados con las presiones recomendadas (163,6±80 frente a 189 ± 66 l/min p < 0,05). Conclusión: El FPT máximo obtenido con el protocolo no siempre coincide con las presiones más altas. Puede ser aconsejable realizar una valoración de IEM evaluada mediante monitorización no invasiva de FPT en pacientes con ENM, especialmente en ELA con afectación bulbar, para mejorar la terapia que detecta el colapso de la vía aérea inducida por altas presiones
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Maximal Respiratory Pressures/methods , Cough/diagnosis , Insufflation/methods , Amyotrophic Lateral Sclerosis/rehabilitation , Respiration, Artificial/methods , Prospective Studies , Cohort Studies , Maximal Respiratory Pressures/instrumentation , Cough/physiopathology , Neuromuscular Diseases/physiopathology , Respiratory Mechanics/physiology , Respiratory Function Tests/methods , Monitoring, PhysiologicABSTRACT
INTRODUCTION: The aim of this study was to assess several air-pressure settings for MI-E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40cmH2O) in patients with neuromuscular disorders (NMD). METHODS: Adults with NMD in whom MI-E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40cmH2O or maximum tolerated), and then 4 adding expiratory pressures (-10, -20, -30 and -40cmH2O or maximum tolerated) with maximum inspiratory pressure previously achieved. RESULTS: Twenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (±40cmH2O) were lower than the scored in the individualized steps of the titration protocol (197.7±67l/min vs 214.2±60l/min, p<0.05). Regarding subgroups, mean PCFmax values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6±80 vs 189±66l/min, p<0.05). CONCLUSION: The PCFmax obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI-E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures.
