Decreased WNT/β-catenin signaling is involved in parenchymal tissue destruction and impaired repair capacity in emphysema. These data indicate a crucial role of WNT/β-catenin signaling in lung repair mechanisms in vivo, and highlight WNT/β-catenin activation as a future therapeutic approach for emphysema.
Zusammenfassung Hintergrund Die außerklinische Beatmung erfährt in Deutschland eine rasante Entwicklung. Patienten mit chronischer respiratorischer Insuffizienz werden in deutlich zunehmender Zahl nichtinvasiv oder invasiv in einem häuslichen Setting beatmet. Diese Patienten müssen im Rahmen von Kontrolluntersuchungen oder Akut-Problemen immer wieder stationär behandelt werden. Die für die Steuerung des Gesundheitswesens wichtige Entwicklung der stationären Behandlungsfälle ist bislang ebenso unbekannt wie die Morbidität und Krankenhaussterblichkeit der häuslich beatmeten Patienten. Methode Von 2006 – 2016 wurden alle stationären Aufnahmen analysiert, bei denen eine Langzeit-Abhängigkeit vom Respirator (mindestens 3 Monate) bestand (Daten des Deutschen Statistischen Bundesamtes). Ergebnisse Es zeigte sich eine exponentielle Zunahme von stationären Behandlungsfällen, wobei 2006 noch 24 845 Patienten stationär behandelt werden mussten, im Jahr 2016 hingegen 86 117 Patienten. Im gleichen Zeitraum zeigte sich eine Abnahme der Krankenhaussterblichkeit von 13,2 % (2006) auf 5,7 % (2016). Im Jahr 2016 wurden zudem 47 % der Patienten auf einer Intensiv-, Weaning- oder Überwachungsstation behandelt. Es bestand eine Vielzahl von internistischen und neurologischen Komorbiditäten, welche in Verbindung mit der chronischen respiratorischen Insuffizienz die große Patientenkohorte als schwer krankes Patientenkollektiv charakterisierte. Führende Diagnosen waren die COPD mit 58 % und eine Vielzahl kardiologischer Diagnosen. Auffällig viele Patienten (24 %) zeigten eine Einschränkung der Nierenfunktion bis hin zur Dialysepflichtigkeit. Diskussion Die rasante Zunahme der außerklinischen Beatmung hat wesentlichen Einfluss auf die Entwicklung der Krankenhauslandschaft in Deutschland. Der exponentielle Anstieg der sehr pflegeintensiven Patienten stellt das Gesundheitssystem vor extreme Herausforderungen und erfordert eine gesundheitspolitische Diskussion über die Grenzen des Systems.
BackgroundAlthough high-intensity non-invasive ventilation has been shown to improve outcomes in stable COPD, it may adversely affect cardiac performance. Therefore, the aims of the present pilot study were to compare cardiac and pulmonary effects of 6 weeks of low-intensity non-invasive ventilation and 6 weeks of high-intensity non-invasive ventilation in stable COPD patients.MethodsIn a randomised crossover pilot feasibility study, the change in cardiac output after 6 weeks of each NIV mode compared to baseline was assessed with echocardiography in 14 severe stable COPD patients. Furthermore, CO during NIV, gas exchange, lung function, and health-related quality of life were investigated.ResultsThree patients dropped out: two deteriorated on low-intensity non-invasive ventilation, and one presented with decompensated heart failure while on high-intensity non-invasive ventilation. Eleven patients were included in the analysis. In general, cardiac output and NTproBNP did not change, although individual effects were noticed, depending on the pressures applied and/or the co-existence of heart failure. High-intensity non-invasive ventilation tended to be more effective in improving gas exchange, but both modes improved lung function and the health-related quality of life.ConclusionsLong-term non-invasive ventilation with adequate pressure to improve gas exchange and health-related quality of life did not have an overall adverse effect on cardiac performance. Nevertheless, in patients with pre-existing heart failure, the application of very high inspiratory pressures might reduce cardiac output.Trial registrationThe trial was registered in the Deutsches Register Klinischer Studien (DRKS-ID: DRKS00007977).Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-017-0542-9) contains supplementary material, which is available to authorized users.
Zusammenfassung Hintergrund Die außerklinische Beatmung erfährt in Deutschland eine rasante Entwicklung. Patienten mit chronischer respiratorischer Insuffizienz werden in deutlich zunehmender Zahl nichtinvasiv oder invasiv in einem häuslichen Setting beatmet. Diese Patienten müssen im Rahmen von Kontrolluntersuchungen oder Akut-Problemen immer wieder stationär behandelt werden. Die für die Steuerung des Gesundheitswesens wichtige Entwicklung der stationären Behandlungsfälle ist bislang ebenso unbekannt wie die Morbidität und Krankenhaussterblichkeit der häuslich beatmeten Patienten. Methode Von 2006 – 2016 wurden alle stationären Aufnahmen analysiert, bei denen eine Langzeit-Abhängigkeit vom Respirator (mindestens 3 Monate) bestand (Daten des Deutschen Statistischen Bundesamtes). Ergebnisse Es zeigte sich eine exponentielle Zunahme von stationären Behandlungsfällen, wobei 2006 noch 24 845 Patienten stationär behandelt werden mussten, im Jahr 2016 hingegen 86 117 Patienten. Im gleichen Zeitraum zeigte sich eine Abnahme der Krankenhaussterblichkeit von 13,2 % (2006) auf 5,7 % (2016). Im Jahr 2016 wurden zudem 47 % der Patienten auf einer Intensiv-, Weaning- oder Überwachungsstation behandelt. Es bestand eine Vielzahl von internistischen und neurologischen Komorbiditäten, welche in Verbindung mit der chronischen respiratorischen Insuffizienz die große Patientenkohorte als schwer krankes Patientenkollektiv charakterisierte. Führende Diagnosen waren die COPD mit 58 % und eine Vielzahl kardiologischer Diagnosen. Auffällig viele Patienten (24 %) zeigten eine Einschränkung der Nierenfunktion bis hin zur Dialysepflichtigkeit. Diskussion Die rasante Zunahme der außerklinischen Beatmung hat wesentlichen Einfluss auf die Entwicklung der Krankenhauslandschaft in Deutschland. Der exponentielle Anstieg der sehr pflegeintensiven Patienten stellt das Gesundheitssystem vor extreme Herausforderungen und erfordert eine gesundheitspolitische Diskussion über die Grenzen des Systems.
Background: Long-term non-invasive ventilation (NIV) is an established and increasingly used treatment option for patients with chronic hypercapnic chronic obstructive pulmonary disease (COPD). Following inpatient NIV establishment, inpatient control visits regularly occur thereafter. However, it remains unclear whether such control visits can also be performed in an outpatient setting, which, in turn, would reduce costs, patient burden and the complications related to hospitalization. Objectives: To investigate an outpatient setting with predefined criteria for hospitalization for patients with chronic hypercapnic COPD. Methods: An outpatient clinic located within the hospital in the vicinity of the respiratory care unit provided predefined criteria for hospitalization of COPD patients receiving long-term NIV therapy. The results of this setting were retrospectively analysed. Results: A total of 130 outpatient visits (80 patients) were analysed. In 93 cases (71.5%), hospital admission was not necessary, while hospitalization was performed in 37 cases (28.5%). Out of these, 7 cases with acute conditions required prompt hospitalization. Patients without hospitalization had better PaCO2 values (45.40 ± 5.27 vs. 50.05 ± 8.04, p = 0.002) and Severe Respiratory Insufficiency Questionnaire Summary scores (55.54 ± 19.74 vs. 41.82 ± 19.59, p = 0.012). Conclusion: Outpatient control of long-term NIV in a hospital setting is feasible and has the capacity to identify stable COPD patients in whom NIV therapy is sufficient according to predefined criteria. These patients may not require hospitalization and may account for more than two thirds of cases.
IntroductionThe establishment of high-intensity (HI) noninvasive ventilation (NIV) that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed.MethodsVentilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV. Daytime arterialized blood gas analyses and lung function testing were also performed. The primary end point was the distribution among study patients of interfaces (full-face masks [FFMs] vs nasal masks [NMs]) in a real-life setting.ResultsThe majority of the 123 patients studied used an FFM (77%), while 23% used an NM. Ventilation settings were as follows: mean ± standard deviation (SD) inspiratory positive airway pressure (IPAP) was 23.2±4.6 mbar and mean ± SD breathing rate was 16.7±2.4/minute. Pressure support ventilation (PSV) mode was used in 52.8% of patients, while assisted pressure-controlled ventilation (aPCV) was used in 47.2% of patients. Higher IPAP levels were associated with an increased use of FFMs (IPAP <21 mbar: 73% vs IPAP >25 mbar: 84%). Mean compliance was 6.5 hours/day, with no differences between FFM (6.4 hours/day) and NM (6.7 hours/day) users. PaCO2 assessment of ventilation quality revealed comparable results among patients with FFMs or NMs.ConclusionThis real-life trial identified the FFM as the predominantly used interface in COPD patients undergoing long-term NIV. The increased application of FFMs is, therefore, likely to be influenced by higher IPAP levels, which form part of the basis for successful application of HI-NIV in clinical practice.
Our data therefore support PtcCO as a suitable means for monitoring PCO in patients undergoing invasive MV. This is in contrast to PetCO , which clearly underestimated PaCO , especially in patients with COPD.
Background: The German guideline on long-term oxygen therapy (LTOT) was published in 2008 by the German Respiratory Society (DGP), while the British Thoracic Society (BTS) published their most recent guideline in 2015. Objectives: The aim of the present article was to highlight the major areas of consensus and disagreement in the recently published BTS and DGP guidelines on LTOT. Methods: The BTS and DGP guidelines were directly compared in terms of congruencies and differences. A critical appraisal was then performed and authors' suggestions were provided. Results: The 2 guidelines are almost congruent in 2 major areas, namely, (1) the indication criteria for LTOT in chronic obstructive pulmonary disease (COPD) patients at rest and (2) the recommended duration of LTOT over a 24-h period. However, 8 major areas in which the guidelines differ considerably were identified: (1) techniques for blood gas analysis; (2) timing of LTOT in stable patients; (3) LTOT in post-exacerbation COPD patients; (4) ambulatory oxygen therapy; (5) nocturnal oxygen therapy; (6) titration of oxygen flow rates; (7) follow-up visits; and (8) LTOT for patients who still smoke. Furthermore, the BTS guideline is much more detailed, includes more references (161 vs. 71) and is more up to date than the DGP guideline. Conclusion: There are major differences between the 2 guidelines. Many of the aspects raised by the BTS guideline appear to be reasonable with regard to the current literature, clinical experience and prescription practices. However, an international consensus on LTOT is lacking.
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