Has the pandemic changed the test quality of the pulmonary function test laboratory?

Introduction: Pulmonary function tests are used in the evaluation of the respiratory system. Maneuvers during spirometry can create aerosols and spread viruses such as SARS-CoV-2. Measures due to the pandemic can negatively affect both the number and the quality of the spirometry tests. There are no comparative studies on this subject. Materials and Methods: The tests conducted in the spirometry laboratory between November 2019 and November 2021 were evaluated. Result: Four hundred forty patients were included in the study. 50.5% of the patients were male and the mean age was 61.8 ± 16.5 years. The age, gender, height, and weight of the patients were similar. 75.2% (331) of the tests were evaluated as successful. The most common errors in tests were early termination (84.1%), uncooperative patients (29%), and poor effort (22.4%). The types of errors were not different between the two periods. The median number of tests performed for each patient was six. The total number of spirometry tests performed were 262 and 178 for 2019 and 2021 (p= 0.011), but test success remained unchanged over the years (p= 0.513). There was no significant difference between the three operators and the test success (p= 0.909), which was similar for both periods. However, the number of tests performed until the successful maneuver varied significantly (p= 0.009), and fewer maneuvers were required before the pandemic. Conclusions: According to this study, the measures taken during the pandemic did not affect the quality of spirometry, but they did lead to more tests being done up until the successful maneuver was performed.

Evaluation of the total face mask for noninvasive ventilation to treat acute respiratory failure.

BACKGROUND: We hypothesized that the total face mask (TFM) would be perceived as more comfortable than a standard oronasal mask (ONM) by patients receiving noninvasive mechanical ventilation (NIV) therapy for acute respiratory failure (ARF) and would be quicker to apply by respiratory therapists. METHODS: Sixty patients presenting with ARF were randomized to receive NIV via either an ONM or a TFM. Mask comfort and dyspnea were assessed using visual analog scores. Other outcomes included time required to apply, vital signs and gas exchange at set time points, and early NIV discontinuation rates (ie, stoppage while still requiring ventilatory assistance). RESULTS: Mask comfort and dyspnea scores were similar for both groups through 3 h of use. The time required to apply the mask (5 min [interquartile range (IQR), 2-8] vs 3.5 min [IQR, 1.9-5]), and duration of use (15.7 h [IQR, 4.0-49.8]) vs 6.05 h [IQR, 0.9-56.7]) were not significantly different between the ONM and the TFM group, respectively. Except for heart rate, which was higher at baseline in the TFM group, no differences in vital signs or gas exchange were detected between the groups during the first 3 h (P > .05). Early NIV discontinuation rates were similar for both the ONM group and TFM group (40% vs 57.1%); however, eight patients in the TFM group were switched to an ONM within 3 h, and none from the ONM group was switched to a TFM (P < .05). CONCLUSIONS: Among patients with ARF requiring NIV, the ONM and TFM were perceived to be equally comfortable and had similar application times. Early NIV discontinuation rates, improvements in vital signs and gas exchange, and intubation and mortality rates were also similar. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00686257; URL: www.clinicaltrials.gov.

Sleep and mechanical ventilation.

Critically ill patients have severe sleep disruption and typically encounter loss of circadian sleep pattern, steep fragmentation, increasing proportions of transitional stages of sleep, and loss of slow wave and rapid eye movement sleep. Mechanical ventilation is associated with these same sleep abnormalities, but what is attributable to the intensive care unit environment versus mechanical ventilation itself may be difficult to discern. Recent studies have shown that the ventilator mode and inappropriate settings can contribute to sleep fragmentation, and it is important to avoid overventilation that can induce central apneas when using spontaneous breathing modes. Noninvasive ventilation in the acute setting seems to be associated with the same sleep abnormalities as invasive ventilation. Long-term noninvasive positive pressure ventilation assists ventilation nocturnally and improves for patients with chronic respiratory failure caused by restrictive thoracic disorders.

Nocturnal noninvasive ventilation.

Nocturnal noninvasive ventilation (NNV), the provision of ventilatory assistance via a noninvasive interface mainly during sleep, has assumed an important role in the management of chronic hypoventilatory syndromes. This review focuses on recent developments related to the use of NNV to treat various forms of chronic respiratory failure or insufficiency. In the past, NNV has been used mainly to treat respiratory insufficiency in patients with neuromuscular disease (NMD) or chest wall deformity; it should be instituted when these patients have orthopnea or daytime symptoms associated with nocturnal hypoventilation. An emerging application is to treat obesity-hypoventilation syndrome, particularly in continuous positive airway pressure (CPAP) failures. Additionally, it has a role in managing some patients with obstructive sleep apnea who are hypoventilating or find the lower expiratory pressure with bilevel positive pressure ventilators more tolerable than with CPAP alone. NNV to treat severe, stable COPD remains controversial, although a subgroup of patients with hypercapnea and sleep-disordered breathing (SDB) seems most likely to respond favorably. NNV to treat central SDB in patients with congestive heart failure continues to be investigated. Recent findings from a Canadian CPAP trial were disappointing, but preliminary results on a novel adaptive NNV mode are promising.

[The effectiveness of thrombolytic therapy in patients with massive and submassive pulmonary thromboembolism]. / Masif ve submasif pulmoner tromboembolide trombolitik tedavi sonuçlarimiz.

Thrombolytic therapy is the most effective therapy for massive pulmonary embolism (PTE). In this study we evaluated the symptoms, clinical and radiologic features and response to thrombolytic therapy in patients who had massive or submassive PTE. Thrombolytic therapy was administered for a mean period of 3 (1-5) hours to 19 patients with a mean age of 63.7 years who had the diagnosis of PTE based on symptoms which lasted for an average of 72 (2-240) hours and findings of echocardiography, spiral computed tomography (CT) angiography and perfusion scan. The patients to whom heparin infusion and oral anticoagulant treatment were given after thrombolytic therapy were evaluated. Bleeding as a complication was noted in six patients after thrombolytic therapy. Two patients died due to this complication. Control spiral CT angiography was performed to 12 of 15 (80%) patients who were initially diagnosed PTE by spiral CT angiography. While marked regression was noted in 5 (41.7%) patients in the early phase (second week), in 7 (58.3%) patients in the late phase (sixth month) PTE findings were completely disappeared. The median value of pulmonary artery pressure was 65 (45-70) mmHg before and 39.5 (30-45) mmHg after the treatment. Of the genetic factors studied before thrombolytic therapy, antithrombin III deficiency was found as the most common one. This study demonstrates that spiral thorax CT angiography is a very accurate diagnostic tool for the definitive diagnosis and transthoracic echocardiography is very useful for the rapid diagnosis and to decide for thrombolytic therapy, in especially patients who are not hypotensive and have submassive to massive PTE, and support the idea that thrombolytic therapy is life saving after reaching the certain diagnosis.