We could not show any benefits for either strategy to withdraw NIV. The study may have been underpowered to detect differences, and larger prospective studies are required.
Home non-invasive ventilation (NIV) is being increasingly employed to treat chronic hypercapnic respiratory failure. However, there is little data on compliance with home NIV. Sixty-five patients, aged 72.6 ± 9.4 years, who were using home NIV were administered a questionnaire on symptomatology and adverse effects associated with home NIV. Mean daily use of home NIV was 7.3 ± 2.9 h/day, and the median percentage of days on which home NIV was used for ≥4 h/day was 96.7%.
Background: Pulmonary nodules (PNs) are increasingly detected by thoracic computed tomography (CT). Traditional diagnostic modalities have their drawbacks. Electromagnetic navigation bronchoscopy (ENB) is gaining popularity in diagnosing small PNs. This study describes the diagnostic yield and complication rate of ENB in diagnosing PNs in which other diagnostic methods are considered to have low yield. Methods: This is a retrospective study of the diagnostic yield and complication rate of ENB performed in the United Christian Hospital, Hong Kong, from April 2015 to June 2016. If a histological diagnosis was deemed necessary and flexible bronchoscopy (FB) was the preferred modality, patients were offered ENB if they have failed a conventional FB with fluoroscopy and radial endobronchoscopic ultrasonography (R-EBUS), or were perceived to have low yield because of the size or position of the PN. Results: During the study period, 99 patients received ENB. An overall of 87 patients had non-resolved CT lesions and had specific pathologies identified (87.9%). The total number of malignant PNs was 67 (67.7%) in the entire cohort and tuberculosis (TB) accounted for 14 PNs (14.1%). The overall accuracy by ENB was 71.7%, sensitivity 67.8%, specificity 100% and negative predictive value 30%. Complications occurred in 3 patients: 1 pneumothorax (1.0%), 1 post-transbronchial biopsy (TBBx) bleeding (1.0%), 1 respiratory failure (1.0%). No patient died as a result of ENB or its complications. Conclusions: For PNs not accessible by conventional FB/R-EBUS, ENB provides good diagnostic yield with low complication rate. It is a useful armamentarium to respiratory physicians and thoracic surgeons.
Electromagnetic navigation bronchoscopy (ENB) is gaining acceptance and popularity amongst bronchoscopists as one of the tools to diagnose pulmonary nodules (PNs). Although the majority of ENBs in earlier studies were performed under general anaesthesia (GA), later reports suggest that the diagnostic yield of ENB under intravenous sedation (IVS) was comparable, and was time saving. ENB under IVS may potentially improve access of the techniques to practitioners and patients. However, it is technically challenging when compared to its performance under GA. This article reviews the techniques required for ENB under IVS to maximize its diagnostic yield and safety.
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