The addition of IV training was more effective for improving some parameters of exercise tolerance and dyspnoea, although did not result in better psychological status nor it was better accepted than the standard PRP in patients with chronic respiratory diseases.

We studied the family's perception of care in patients under home mechanical ventilation during the last 3 months of life.In 11 respiratory units, we submitted a 35-item questionnaire to relatives of 168 deceased patients exploring six domains: symptoms, awareness of disease, family burden, dying, medical and technical problems.Response rate was 98.8%. The majority of patients complained respiratory symptoms and were aware of the severity and prognosis of the disease. Family burden was high especially in relation to money need. During hospitalisation, 74.4% of patients were admitted to the intensive care unit (ICU). 78 patients died at home, 70 patients in a medical ward and 20 in ICU. 27% of patients received resuscitation manoeuvres. Hospitalisations and family economical burden were unrelated to diagnosis and mechanical ventilation. Families of the patients did not report major technical problems on the use of ventilators. In comparison with mechanical invasively ventilated patients, noninvasively ventilated patients were more aware of prognosis, used more respiratory drugs, changed ventilation time more frequently and died less frequently when under mechanical ventilation.We have presented good points and bad points regarding end-of-life care in home mechanically ventilated patients. Noninvasive ventilation use and diagnosis have impact on this burden.

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The aim of the present study is to analyse changes in the diaphragmatic electromyography integral, as a direct expression of the patients inspiratory effort and index of neural respiratory drive, and parameters associated with ventilatory function in patients with prolonged weaning under Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatoy Assist (NAVA). Five patients affected by neuromuscular diseases were recruited. Each patient underwent a sequence of decreasing inspiratory support levels under NAVA and PSV, randomly assigned, from a baseline to a final level. At baseline, the value of diaphragmatic electromyography integral was higher under NAVA compared to PSV and increased in both ventilation modes progressing to final level. Higher values of inspiratory time and neural inspiratory time were observed in PSV at final level compared to baseline level. Conversely, a significant decrease of neural inspiratory time from baseline level to final level was observed in NAVA. Tidal volume at final level was significantly lower than at baseline level in both ventilation modes. These preliminary results show that in prolonged weaning patients affected by neuromuscular disease NAVA ventilation is associated to a higher diaphragmatic electromyography activity compared to PSV with same level of ventilation and subjective comfort