Background and objective
Average volume‐assured pressure support—automated expiratory positive airway pressure (AVAPS‐AE) combines an automated positive expiratory pressure to maintain upper airway patency to an automated pressure support with a targeted tidal volume. The aim of this study was to compare the effects of 2‐month AVAPS‐AE ventilation versus pressure support (ST) ventilation on objective sleep quality in stable patients with OHS. Secondary outcomes included arterial blood gases, health‐related quality of life, daytime sleepiness, subjective sleep quality and compliance to NIV.
Methods
This is a prospective multicentric randomized controlled trial. Consecutive OHS patients included had daytime PaCO2 > 6 kPa, BMI ≥ 30 kg/m2, clinical stability for more than 2 weeks and were naive from home NIV. PSG were analysed centrally by two independent experts. Primary endpoint was sleep quality improvement at 2 months.
Results
Among 69 trial patients, 60 patients had successful NIV setup. Baseline and follow‐up PSG were available for 26 patients randomized in the ST group and 30 in the AVAPS‐AE group. At baseline, PaCO2 was 6.94 ± 0.71 kPa in the ST group and 6.61 ± 0.71 in the AVAPS‐AE group (P = 0.032). No significant between‐group difference was observed for objective sleep quality indices. Improvement in PaCO2 was similar between groups with a mean reduction of −0.87 kPa (95% CI: −1.12 to −0.46) in the ST group versus −0.87 kPa (95% CI: −1.14 to −0.50) in the AVAPS‐AE group (P = 0.984). Mean NIV use was 6.2 h per night in both groups (P = 0.93). NIV setup duration was shorter in the AVAPS‐AE group (P = 0.012).
Conclusion
AVAPS‐AE and ST ventilation for 2 months had similar impact on sleep quality and gas exchange.
With first cases noted towards the end of 2019 in China, COVID-19 infection was rapidly become a devastating pandemic. Even if most patients present with a mild to moderate form of the disease, the estimated prevalence of COVID-19-related severe acute respiratory failure (ARF) is 15-20% and 2-12% needed intubation and mechanical ventilation. In addition to mechanical ventilation some other techniques of respiratory support could be used in some forms of COVID-19 related ARF. This position paper of the Respiratory Support and Chronic Care Group of the French Society of Respiratory Diseases is intended to help respiratory clinicians involved in care of COVID-19 pandemic in the rational use of non-invasive techniques such as oxygen therapy, CPAP, non-invasive ventilation and high flow oxygen therapy in managing patients outside intensive care unit (ICU). The aims are: (1) to focus both on the place of each * Corresponding author.
Cemiplimab is currently the only immune checkpoint inhibitor treatment approved for advanced cutaneous squamous cell carcinoma (CSCC). 1,2 While other programmed cell death protein-1 (PD-1) antibodies are treatment options for advanced or metastatic non-small cell lung cancer (NSCLC), the use of cemiplimab is still under study for this cancer 3 and has not received formal approval. We present the
Resumen. El propósito del artículo se centra en el Diseño y desarrollo de una aplicación móvil para apoyar la navegación individual y localización de personas de la tercera edad con discapacidad visual. Para el desarrollo de la aplicación móvil, se utilizó la metodología Extreme Programación, el Diseño Universal, y las tecnologías integradas de WebService, PHP, MYSQL, Java y Apache. La aplicación permite la ubicación del sujeto y compartirla entre distintos usuarios, con la finalidad de brindar seguridad y facilitar una mayor inclusión del uso de la tecnología a esta población. Finalmente se presentan los resultados obtenidos de una prueba piloto mediante la experiencia de los usuarios en distintos escenarios.
Abstract:The purpose of this article is focused on the design and development of an accessible mobile app of individual navigation and location for elder people with visual disability. To develop the mobile application, it was used as methodology Extreme Programming, el Universal Design, integrated technologies of WebService, PHP, MYSQL, Java and Apache. The app allows to know the man's location and share it within many users providing security and facilitate a better inclusion of the use of technology to this kind of population. Finally the article shows results obtained from a pilot test through the user's experience in different scenarios.
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