Pulmonary function, in¯ammation, exercise capacity and quality of life in cystic ®brosis. J. Bradley, O. McAlister, S. Elborn. #ERS Journals Ltd 2001. ABSTRACT: The aim of the study was to determine the extent to which treatment induced changes in exercise capacity and quality of life (QoL) are related to spirometric measures of lung function and other measures of disease impairment.Twenty patients admitted to hospital with an exacerbation of pulmonary disease were recruited. Measures of disease impairment, disability and QoL were obtained at the beginning and end of an intravenous course of antibiotic therapy.Intravenous antibiotic treatment resulted in a signi®cant improvement in all measures of disease impairment, disability and handicap. The only signi®cant predictor of treatment induced change in exercise capacity was C-reactive protein (CRP) and this explained 28% of the variance in change in exercise capacity. In the case of QoL, two predictors (change in exercise capacity and sputum output) contributed signi®cantly to the change in QoL and collectively explained 54% of the variance in QoL.Lung function provides a limited index of treatment outcome. Exercise capacity and quality of life assessment have the potential to make a signi®cant contribution to the decision making process regarding treatment choices in cystic ®brosis and should be measured directly if a comprehensive evaluation of the effect of treatment is required. Eur Respir J 2001; 17: 712±715.

In this porcine model of induced cardiac arrest moderate within animal correlations were observed between mechanical and physiological markers of chest compression efficacy demonstrating the challenge in utilising a single mechanical metric to quantify chest compression efficacy. ICG amplitude demonstrated strong within animal correlations with compression depth and ETCO2 suggesting its potential utility to provide CPR feedback in the out of hospital setting to improve performance.

BackgroundPublic access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a retrospective observational cohort study, describing real-world PAD utilisation over a 5-year period.MethodsData were collected between October 2012 and October 2017. Responders voluntarily submitted electronic data downloaded from HeartSine PADs, and patient demographics and other details using a case report form in exchange for a replacement battery and electrode pack.ResultsData were collected for 977 patients (692 males, 70.8%; 255 females, 26.1%; 30 unknown, 3.1%). The mean age (SD) was 59 (18) years (range <1 year to 101 years). PAD usage occurred most commonly in homes (n=328, 33.6%), followed by public places (n=307, 31.4%) and medical facilities (n=128, 13.1%). Location was unknown in 40 (4.09%) events. Shocks were delivered to 354 patients. First shock success was 312 of 350 patients where it could be determined (89.1%, 95% CI 85.4% to 92.2%). Patients with reported response times ≤5 min were more likely to survive to hospital admission (89/296 (30.1%) vs 40/250 (16.0%), p<0.001). Response time was unknown for 431 events.ConclusionThis is the first study to report global PAD usage in voluntarily submitted, unselected real-world cases and demonstrates the real-world effectiveness of PADs, as confirmed by first shock success.

A questionnaire on inhalers was sent to all patients at the Northern Ireland Regional Adult Cystic Fibrosis Centre. The results showed widespread use of inhalers. Most patients perceived symptomatic benefit from inhalers, but 50% did not use them according to an agreed protocol. Education on the correct use of their inhalers is important to optimize patient benefit.

A twelve-animal porcine study dataset was retrospectively analyzed to assess associations between chest compression (CC) depth, systolic blood pressure (SBP) and end-tidal carbon dioxide (EtCO2). Manual CCs were applied for 7 two-minute episodes, at CC depths between 10mm-55mm. A rolling 15s analysis window was applied to the continuous signals. Mean peak values were calculated for each window. Correlation analysis was applied to assess strength of association. Optimal CC depth to achieve physiological targets was determined via cutoff analysis. A total of 672 observations for each variable were available for analysis. Pearson correlations (95% confidence interval; p-value) between CC depth and both SBP and ETCO2 were 0.84 (0.82, 0.86; p < 0.001) and 0.75 (0.71, 0.78; p < 0.001) respectively. Optimal CC depth cutoff (sensitivity, specificity) to achieve SBP ≥ 100mmHg and EtCO2 ≥ 10mmHg was 33 mm (98.29%, 88.94%) and 20 mm (95.08%, 78.30%) respectively. A reasonable relationship between CC depth and physiological response was observed. Optimal SBP and EtCO2 cutoffs were achieved significantly below guideline depths. Furthermore, cutoff analysis suggests a disparity between CC depth and physiological targets.