In highly selected critically ill patients, dexmedetomidine infusion during the night to achieve light sedation improves sleep by increasing sleep efficiency and stage 2 and modifies the 24-h sleep pattern by shifting sleep mainly to the night.

No abstract

Survivors of critical illness exhibited a high prevalence of obstructive sleep-disordered breathing and poor sleep architecture at hospital discharge, which slightly improved 6 months later, indicating that reversible factors are partly responsible for these abnormalities.

Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the combination of upper lobe emphysema and lower lobe fibrosis, the latter owing to various interstitial lung diseases. These patients have a characteristic lung function profile, with relatively preserved dynamic and static lung volumes, contrasting with a significant reduction of carbon monoxide transfer. The pathogenic mechanisms leading to the coexistence of emphysema with fibrosis remain unclear and different theories have been proposed. CPFE is frequently complicated by pulmonary hypertension, acute exacerbations, and lung cancer leading to poor natural history and prognosis. The syndrome of CPFE represents a distinct pulmonary manifestation in the spectrum of lung diseases associated with connective tissue diseases. Currently, there are no established recommendations regarding the management of patients with CPFE. We provide a review on the existing knowledge of CPFE regarding the epidemiology, pathogenesis, clinical manifestations, radiologic appearance, complications, prognosis, and possible treatment options.

Early in the pandemic era of COVID-19 the term "happy or silent hypoxia" was introduced to describe patients with COVID-19 who presented with severe hypoxemia and absence of dyspnea (Couzin-Frankel, 2020;Guan et al., 2020). The absence of dyspnea despite severe hypoxemia was considered to be a "paradox" and unique to COVID-19 (Archer et al., 2020;Ferenchick and Ferenchick, 2020). As such the term "happy or silent hypoxia" has been received wide attention by the press and social media and even described as a silent killer in COVID-19 (Levitan, 2020). Although scientific evidence is lacking, central nervous system viral invasion has been put forward to explain this "paradox" (Nouri-Vaskeh et al., 2020;Gopal et al., 2021;Tavčar et al., 2021). Nevertheless, basic principles of respiratory system physiology dictate that the absence of dyspnea despite severe hypoxemia is not specifically linked to COVID-19 but to other lung diseases as well (Tobin et al., 2020). The aim of our article is to present information about the responses to both acute and sustained hypoxia and provide an analysis of control of breathing physiology that could explain the absence of dyspnea despite severe hypoxemia. Specifically, we apply in hypoxemic patients with COVID-19 our currently published analysis (Vaporidi et al., 2020) that relates arterial carbon dioxide levels with respiratory centers response to this stimulus, contrasting the brain's responses to the patient's ability to generate effective alveolar ventilation. This analysis may facilitate comprehension of the pathophysiology of dyspnea in hypoxemic patients with COVID-19.

Objectives-In this study, we sought to assess the validity of lung ultrasound (LUS) during the follow-up of patients with a wide spectrum of interstitial lung diseases (ILDs).Methods-Twenty-four patients (13 males, 11 females; mean age AE SD, 65.4 AE 14.3 years; age range, 40-84 years) with a diagnosis of ILDs who were admitted to the Interstitial Lung Disease Unit were prospectively enrolled. Patients were examined with a 56-lung intercostal space LUS protocol in lateral decubitus position, at baseline, 6-months, and 1-year. The LUS score was defined as the sum of B-lines counted in each intercostal space. All patients underwent complete pulmonary function tests at baseline and follow-up timepoints. High-resolution computed tomography (HRCT) was performed at baseline and during follow-up, according to personalized patients' needs. All HRCT studies were graded according to the Warrick scoring system (WS).Results-Pooled data analysis showed a significant correlation between WS and LUS scores (P < .001). For separate time-point analysis, a significant correlation between LUS scores and WS was found at baseline (P < .001) and 1 year (P = .005). LUS scores negatively correlated with alveolar volume (VA) (P < .046) and diffusing capacity for carbon monoxide (DLCO) (P < .001) at 6 months and with transfer coefficient of the lung for carbon monoxide (KCO) (P < .031) and DLCO (P = .002) at 12-months. A multivariate regression model showed DLCO to be an independent predictor of LUS score at 1 year (P = .026).Conclusions-Our results highlight the validity and potential applicability of LUS for disease monitoring in a wide spectrum of ILDs.

SARS-coronavirus-2 (SARS-CoV-2), the etiologic agent of the new lung disease COVID-19 is closely related to SARS-CoV, and together with MERS-CoV are three new human coronaviruses that emerged in the last 20 years. The COVID-19 outbreak is a rapidly evolving situation with higher transmissibility and infectivity compared with SARS and MERS. Clinical presentations range from asymptomatic or mild symptoms to severe illness. The prevalent cause of mortality is pneumonia that progresses to ARDS. The ongoing pandemic has already resulted in more than 135,000 deaths and an unprecedented burden on national health systems worldwide. Pending the availability of a vaccine, there is a critical need to identify effective treatments and a number of clinical trials have been implemented worldwide. Trials are based on repurposed drugs that are already approved for other infections, have acceptable safety profiles or have performed well in animal studies against the other two deadly coronaviruses. Supportive care remains the mainstay of therapy at present, as it is still unclear how well these data can be extrapolated to SARS-CoV-2. Most of those emerging reintroduced drugs are administered to patients in the context of clinical trials. In this review, we summarize the strategies currently employed in the treatment of COVID-19.

Coronavirus disease 2019, a respiratory tract infection that has evolved into a pandemic, is expected to affect patients with underlying respiratory disease in a greater number and greater severity than patients with other underlying disorders. Whether this is true is an interesting question. However, the challenge both for the doctors and patients is to keep the respiratory disease in remission and prevent any exacerbations. Proper recommendations have been proposed for a wide range of respiratory disorders including chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases, regarding the continuation or not of the treatment during this period and ways to maintain stability.