Introduction Some COVID-19 patients develop respiratory failure requiring admission to intensive care unit (ICU). We aim to evaluate the effects of pulmonary rehabilitation (PR) post-ICU in COVID-19 patients. Methods Twenty-one COVID-19 patients were evaluated pre- and post-PR and compared retrospectively to a non-COVID-19 group of 21 patients rehabilitated after ICU admission due to respiratory failure. Results PR induced greater 6-min walking distance improvement in COVID-19 patients (+205 ± 121 m) than in other respiratory failure patients post-ICU (+93 ± 66 m). The sooner PR was performed post-ICU, the better patients recovered. Conclusions PR induced large functional improvements in COVID-19 patients post-ICU although significant physical and psychosocial impairments remained post-PR.

Study Objectives: Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients. Design: A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention. Setting: Sleep clinics in France. Patients or Participants: 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention). Interventions: Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages. Measurements: The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life. Results: Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention. Conclusions: CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients. Clinical Trials Registration: ClinicalTrials.gov identifier: NCT01226641.

The repeatability (i.e., the variation in repeated measurements of the same quantity) of the protected specimen brush (PSB) with quantitative cultures was assessed in 22 consecutive mechanically ventilated (MV) patients with suspected nosocomial pneumonia. Five PSB samples were collected in the same lung area during the same bronchoscopic procedure and processed for bacteriologic identification and quantitative culture. A laboratory control was also performed in order to assess the in vitro repeatability of the quantitative culture technique. The five PSB always recovered the same microorganisms, indicating a 100% qualitative repeatability for the PSB. Conversely, the quantitative repeatability was somewhat lower since in 59% of the patients the quantitative results varied by more than one log10, which is the minimal precision affordable with quantitative cultures. The distinction between presence or absence of infection based on the 10(3) cfu/ml recommended diagnostic threshold was, however, only moderately affected by the variability of the quantitative results since only three of 22 patients (13.6%) displayed results spread out on each side of the 10(3) cfu/ml break point. Intrasubject variability of quantitative results was not explained by problems with the quantitative culture technique, which proved excellent repeatability in the laboratory. This study indicated that, although the PSB technique with quantitative cultures displays an acceptable level of repeatability, caution is advisable when interpreting PSB results in critically ill patients with suspected pneumonia, especially if one refers to the 10(3) cfu/ml recommended diagnostic threshold and if a decision to treat or to abstain from treating is to be made.

Auto bi-level with pressure relief during exhalation treats OSA as effectively as CPAP without inducing additional arousals. Transitioning non-compliant CPAP patients without modifiable causes of poor compliance from their CPAP to this new device improves compliance and clinical outcomes over a 10-week period.