The edition · Pulmonology
Structured rehabilitation nearly quadrupled weaning success in ventilated patients over 80
A single-centre randomised trial in prolonged mechanical ventilation; the CPAP comfort setting that let the airway narrow; high-intensity intervals matched standard rehabilitation in fibrotic lung disease; and why TB care should not end at cure.
The edition in brief
A single-centre, assessor-blinded randomised trial in China assigned 150 patients aged 80 or over on prolonged mechanical ventilation to a multicomponent pulmonary rehabilitation programme or standard rehabilitation. Successful weaning was 45.3% against 12.0% (adjusted HR 5.11), with better diaphragm function, cough and muscle strength and less ventilator-associated pneumonia; 90-day mortality was low and similar. In 29 adults with severe sleep apnoea, CPAP expiratory pressure relief lowered inspiratory flow, needed higher titrated pressure (11.4 vs 9.2 cmH2O) and left a higher residual AHI, without improving adherence. A randomised trial of 131 people with fibrotic interstitial lung disease found high-intensity interval training no better than moderate continuous training for endurance, but safe. In 215 patients with COPD, CT mucus plugs and emphysema were each associated with about three times the odds of exacerbation. A Cambodian cohort found respiratory symptoms, depression and stigma persisting two years after TB treatment.
Breathlessness, depression and stigma persisted two years after TB treatment
Follow up TB survivors for persistent respiratory symptoms and depression after cure, with spirometry where symptoms continue.
CPAP expiratory pressure relief narrowed the airway and raised residual AHI
In severe sleep apnoea, consider keeping CPAP expiratory pressure relief off; it worsened airway patency without improving adherence.
High-intensity interval training matched standard rehabilitation in fibrotic ILD
Refer patients with fibrotic ILD for pulmonary rehabilitation; interval and continuous training worked equally well.
CT mucus plugs and emphysema were linked to COPD exacerbations
Take note of mucus plugs on existing CT in COPD as a possible marker of exacerbation risk, alongside exacerbation history.
Check inhaler technique before stepping up COPD or asthma treatment
Watch the patient use their inhaler and fix technique before adding or changing a drug.
Multicomponent rehabilitation raised weaning success in ventilated patients over 80
Offer a structured multicomponent rehabilitation programme to patients aged 80 or over on prolonged ventilation; age alone should not rule out weaning.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for pulmonology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free