01. Clinical
Pulmonary rehabilitation in interstitial lung disease: benefits and predictors of response.
Ferreira A, Garvey C, Connors GL, Hilling L, Rigler J, Farrell S, Cayou C, Shariat C, Collard HR. Chest 2009 135(2): 442-7.
Data examining the role of pulmonary rehabilitation (PR) in interstitial lung disease (ILD) are limited. This study suggests that PR should be considered as a standard of care for patients with ILD.
A randomized trial of CT fluoroscopic-guided bronchoscopy vs conventional bronchoscopy in patients with suspected lung cancer.
Ost D, Shah R, Anasco E, Lusardi L, Doyle J, Austin C, Fein A. Chest 2008 134(3): 507-13.
Prior case series have shown promising diagnostic sensitivity for CT scan-guided bronchoscopy. This prospective randomized trial failed to demonstrate a significant difference between CT scan-guided bronchoscopy and conventional bronchoscopy for the diagnosis of lung cancer in peripheral lesions and mediastinal lymph nodes.
A new diagnostic rule for deep vein thrombosis: safety and efficiency in clinically relevant subgroups.
Toll DB, Oudega R, Vergouwe Y, Moons KG, Hoes AW. Fam Pract 2008 25(1): 3-8.
Recently, a new, simple diagnostic rule was introduced to enable GPs to safely refrain from referring a considerable proportion of the patients suspected of having deep vein thrombosis (DVT). The rule (which includes seven patient history and physical examination items plus the result of a D-dimer test) discriminates 'very low' risk patients (not to be referred) from patients with an increased risk of DVT (to be referred). This papers concludes that the rule can safely exclude DVT in primary care patients suspected of DVT, irrespective of age, gender and history of DVT.
Effect of a home exercise video programme in patients with chronic obstructive pulmonary disease.
Moore J, Fiddler H, Seymour J, Grant A, Jolley C, Johnson L, Moxham J. J Rehabil Med 2009 41(3): 195-200.
This pilot study investigated whether a home exercise video programme could improve exercise tolerance and breathlessness in patients with moderate to severe chronic obstructive pulmonary disease. The median change in the Incremental Shuttle Walk Test and breathlessness score significantly improved in the intervention group compared with the control. This study suggests that participation in a home exercise video programme may benefit people with chronic obstructive pulmonary disease. This technique opens a new way of carrying rehabilitation care to the patients’ home.
Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm.
Brady MJ, Thomas J, Wong TZ, Franklin KM, Ho LM, Paulson EK.Radiology 2009 250(2): 523-30.
The presence of Adrenal nodules remains a clinical problem in the staging of lung cancer, often requiring invasive techniques. This study aimed to develop an algorithm to maximize the diagnostic yield of positron emission tomography (PET)/computed tomography (CT) by using defined attenuation and standardized uptake value (SUV) criteria. Definitive identification of many metastases can be accomplished by applying an SUV ratio cutoff of greater than 2.5, allowing pragmatic management of adrenal nodules that initially test positive with the combined PET/CT criteria SUV(max) > 3.1 and mean attenuation > 10 HU.
Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society.
Bradley B, Branley HM, Egan JJ, Greaves MS, Hansell DM, Harrison NK, Hirani N, Hubbard R, Lake F, Millar AB, Wallace WA, Wells AU, Whyte MK, Wilsher ML; British Thoracic Society Interstitial Lung Disease Guideline Group, British Thoracic Society Standards of Care Committee; Thoracic Society of Australia; New Zealand Thoracic Society; Irish Thoracic Society. Thorax 2008 63(Suppl 5): v1-58.
This is the new Interstitial lung disease guideline by the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society
02. Respiratory Intensive Care
Noninvasive pressure-support ventilationin immunocompromised children with ARDS:
Piastra M, De Luca D, Pietrini D,Pulitano` S, D’Arrigo S, Mancino, Cont G Intensive Care Med 2009 Published ahead of print DOI 10.1007/s00134-009-1558-5
There is paucity of literature on the use of non-invasive ventilation (NIV) in children with ARDS. The aim of this not randomized trial was to verify the feasibility of NIV through a face mask or a helmet in twenty-three consecutive immunocompromised children affected by ARDS. Early and sustained improvement in PaO2/FiO2 ratio were observed in 82 and 74% of cases, respectively. 13 out of 23 patients (54.5%) avoided intubation and were discharged from the PICU; ten patients required intubation: two ofthem survived and eight patients died.NIVresponders had significantly lowerheart and respiratory rate at the end of treatment . The authors concluded that although NIV administration is a feasible in immunocompromised children with ARDS a randomized controlled trial is needed
to confirm the efficacy of NIV
Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis.
G.P. Ferreyra, I. Baussano, V. Squadrone, L. Richiardi, G. Marchiaro, L. Del Sorbo, L. Mascia, F. Merletti, V.M. Ranieri.Ann Surg. 2008 247(4):617-26
This is a very interesting systematic review on the use of positive airway pressure (CPAP) to prevent postoperative pulmonary complications (PPCs), atelectasis, pneumonia, and intubation in patients undergoing major abdominal surgery. CPAP was found to reduce the risk of PPCs, atelectasis, and pneumonia in patients undergoing abdominal surgery. This study also suggests that postoperative CPAP displays a beneficial effect on the risk of endotracheal intubation.
This study confirms that CPAP is a simple tool that must be taken into account to prevent respiratory complication in abdomimal surgery
Intentional leaks in industrial masks have a significant impact on efficacy of bilevel noninvasive ventilation: a bench test study
Borel JC, Sabil AK, Janssens JP, Couteau M, Boulon L, Lévy P,Pépin JL Chest 2009 135 (3):669–677
During noninvasive ventilation, non intentional leaks have a detrimental effect on he efficacy of ventilation. When using intentional leaks circuit. intentional leaks may differ among different industrial interfaces that have a built in “vent system”. The present study went to measure intentional leaks in seven different industrial masks and to determine whether higher leaks modify ventilator performance and quality of ventilation. The level of intentional leaks in the seven masks ranged from 30 to 45 L/min for an IPAP of 14 cm H2O. The amount of leaks did not influence trigger performances but interfere with the capacity to achieve and maintain the preset IPAP especially when > 40 L/min.
Physiological effects of different interfaces during noninvasive ventilation for acute respiratory failure
Tarabini Fraticelli A, Lellouche F, L’Her E, Taille S , Mancebo J, Brochard L Crit Care Med 2009 2009 37:939 –945
Durng noninvasive ventilation (NIPPV) hypercapnic acidosis in the first hours of NIPPV may be, in part, also potentially influenced by the dead space (internal volume-IV) of the interface. The present crossover randomized physiologic study tested the short-term physiologic effects (indexes of respiratory effort, ventilation, and gas exchange), leaks, patient-ventilator asynchrony, and comfort of four NIPPV interfaces with major differences in IV. They concluded that the IV of the interfaces with the exception of mouthpiece, had no apparent short-term effect on the above mentioned measured parameters suggesting that, interfaces may be interchangeable provided adjustment of the ventilatory parameters are performed.
A bench study of intensive-care-unit
Thille AW,Lyazidi A, Richard JCM et al Intensive Care Med 2009 35:1368–1376
This is a very interesting article making the point on the up to date differences between the high pressure gas ( compressed-air) and turbine driven ventilators of the last generation. Taking into account that the tested turbine driven ventilator were designed for the use in the critical care area (they all allows to set a given oxygen concentration in order to have a constant oxygen) the results are very interesting.
The present article deals with an evaluation (bench study) of new versus old generation of compressed air driven ventilators. The study also compared turbine driven ventilators versus compressed gas driven ventilators,
On average, turbine-based ventilators performed better than conventional ventilators. ICU compressed air driven ventilators seem to have reached a technical ceiling in recent years. The authors concluded that no improvement were found when data were compared to a bench comparison performed in 2000. (Richard JC et al Intensive Care Med 2002; 28:1049–1057) and some ventilators still perform inadequately.
Cephalic versus oronasal mask for noninvasive ventilation in acute hypercapnic respiratory failure
Cuvelier A, Pujol W, Pramil S, Molano LC, Viacroze C, Muir JF Intensive Care Med 2009 35(3):519–526
Compared to oronasal interfaces, a cephalic total full face mask (TFFM) has a larger inner volume . However a TFFM may limit the risk of skin breakdown because it does not lie on nasal bridge. The present clinical randomized study aimed to compare the clinical efficacy of a TFFM versus an oronasal mask (FM) in 34cpatients with acute hypercapnic respiratory failure. Compared to values at inclusion, pH, PaCO2 , encephalopathy score, respiratory distress score and respiratory frequency improved significantly and similarly with both masks. Tolerance of the oronasal mask was improved at 24 h and further. The authors concluded that in spite of its larger inner volume, the cephalic mask has the same clinical efficacy and equires the same ventilatory settings as the oronasal mask during AHRF.
Interfaces and Humidification for Noninvasive Mechanical Ventilation
Nava S, Navalesi P, Gregoretti CRespir Care 2009 54(1):71– 82.
This review outlines the importance of patient's comfort when noninvasive ventilation (NIPPv) is applied in acute respiratory failure. Mask fit and care in heating and humidifying dry gases may be needed to prevent skin damage,air leaks and to prevent adverse effects from cool dry gas. Therefore choice of interface and type of humidification may become a major determinant of NIPPV success or failure. Every effort should be made to minimize air leaks, maximize patient comfort, and optimize patient-ventilator interaction.
05. Inflammatory Airway Diseases and Clinical Allergy
Prevalence, pathogenesis, and causes of chronic cough
Kian Fan Chung , Ian D Pavord The Lancet 2008 371 : 1364-1374
Chronic cough lasting for more than 8 weeks is common in the community, has many causes and can be difficult to manage. The physiology, causes, work-up and management of chronic cough are succinctly reviewed in these two articles, which will be frequently referred to by the busy clinician.
Management of chronic cough
Ian D Pavord , Kian Fan Chung The Lancet 2008 371 : 1375-1384
Chronic cough lasting for more than 8 weeks is common in the community, has many causes and can be difficult to manage. The physiology, causes, work-up and management of chronic cough are succinctly reviewed in these two articles, which will be frequently referred to by the busy clinician.
10. Respiratory Infections
Comparative Performance of Tuberculin Skin Test, QuantiFERON-TB-Gold In Tube Assay, and T-Spot.TB Test in Contact Investigations for Tuberculosis
Diel R, Loddenkemper R, Meywald-Walter K, Gottschalk R, Nienhaus AChest 2008 Nov 18. [Epub ahead of print]
Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia
Restrepo MI, Mortensen EM, Waterer GW, Wunderink RG, Coalson JJ, Anzueto AEur Respir J 2009 Jan;33(1):153-9
Frequency and clinical relevance of human bocavirus infection in acute exacerbations of chronic obstructive pulmonary disease
Ringshausen FC, Tan AM, Allander T, Borg I, Arinir U, Kronsbein J, Hauptmeier BM, Schultze-Werninghaus G, Rohde GInt J Chron Obstruct Pulmon Dis 2009 4:111–17
This recent open access research paper provides first evidence on the role of the emerging respiratory virus human bocavirus in a population of patients with acute excerbation of COPD.
Infection in the pathogenesis and course of chronic obstructive pulmonary disease
Sethi S, Murphy TFN Engl J Med 2008 Nov 27;359(22):2355-65
Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults
Garbino J, Soccal PM, Aubert JD, Rochat T, Meylan P, Thomas Y, Tapparel C, Bridevaux PO, Kaiser LThorax 2009 2009 Jan 27 [Epub ahead of print]
11. Thoracic Oncology Section
Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups
Strauss GM, Herndon JE, Maddaus MA, Johnstone DW, Johnson EA, Harpole DH, et al.Journal of Clinical Oncology 2008 2008;26:5043-51
First study on adjuvant chemotherapy in a homogeneous population of resected pathological stage IB non-small cell lung cancer, pointing at a potential benefit of adjuvant chemotherapy in patients with a larger-sized primary tumour.
Phase III study of immediate compared with delayed docetaxel after front-line therapy with gemcitabine plus carboplatin in advanced non-small cell lung cancer.
Fidias PM, Dakhil SR, Lyss AP, Loesch DM, Waterhouse DM, Bromund JL, et al.Journal of Clinical Oncology 2009 2009;27:591-8
First study of its kind looking at the optimal timing of a 2nd therapy for advanced NSCLC. Giving docetaxel immediately after 1st line doublet chemotherapy (i.e. “early docetaxel”, some call this “maintenance therapy with docetaxel”) siginificantly improved progression-free survival with a trend for improved overall survival as well.
Screening for malignant pleural mesothelioma and lung cancer in individuals with a history of asbestos exposure.
Roberts HC, Patsios DA, Paul NS, DePerrot M, Teel W, Bayanati H, Shepherd F, Johnston MRJournal of Thoracic Oncology 2009 2009 May;4(5):620-8
Description: malignant mesothelioma is a cancer with a very dismal prognosis. Current data suggest that early multimodal treatment associating surgery and chemotherapy may decrease mortality and even lead to cure in a limited number of patients. However most cases are diagnosed late in the course of the disease. Hence there is a need to develop an efficient method for screening patient at risk for the disease. The use of blood markers has resulted in a large number of false positive (park et al Am J Respir Crit Care Med. 2008 Oct 15;178(8):832-7). Therefore the interest has turned toward imagistic methods of detection. The thoracic CT scan may be an alternative. The proposed paper report the second trial published on this matter and gives hope that CT scan may be an useful methods for early detection of malignant mesothelioma.
