Effect of high-flow nasal cannula oxygen therapy on exercise tolerance in patients with idiopathic pulmonary fibrosis: A randomized crossover trial.

BACKGROUND AND OBJECTIVE: Exercise capacity in idiopathic pulmonary fibrosis (IPF) is limited by exercise-induced hypoxaemia. This study aimed to examine the effect of high-flow nasal cannula oxygen therapy (HFNC) on exercise tolerance in patients with IPF. METHODS: We conducted a single-centre, open-label, randomized crossover trial to compare HFNC and Venturi mask (VM) therapy in terms of exercise tolerance. Patients underwent constant-load symptom-limited exercise testing at 80% peak work rate with HFNC or a VM in a randomized order. The settings were 60 L/min and a 50% fraction of inspired oxygen (FiO2 ) for HFNC and 12 L/min and 50% FiO2 for VM. The primary outcome was endurance time, and the secondary outcomes were heart rate (HR), percutaneous oxygen saturation (SpO2 ), dyspnoea and leg fatigue, as determined by the modified Borg Scale at the isotime and endpoint, and the level of comfort while using the devices. RESULTS: Twenty-four participants (75.0% men; age, median [interquartile range]: 77.5 [68.8-83.0] years) were enrolled. Compared with VM, HFNC significantly improved the endurance time (647.5 s [454.0-1014.8] vs. 577.5 s [338.0-861.5]), minimum SpO2 (96.0% [95.0-98.0] vs. 94.0% [92.8-96.0]) and leg fatigue at the isotime (3.0 [1.6-4.0] vs. 5.0 [3.0-6.3]) and endpoint (4.0 [2.8-5.0] vs. 5.0 [3.8-6.3]). Differences in maximum HR, dyspnoea at the isotime and endpoint and comfort were non-significant between HFNC and VM therapy. CONCLUSION: HFNC increased exercise tolerance in patients with stable IPF experiencing exercise-induced hypoxaemia.

Preoperative physical performance-related postoperative delirium in patients after cardiovascular surgery.

OBJECTIVES: This investigation clarified the relationship between a short physical performance battery (SPPB) that can comprehensively and safely evaluate balance function, walking ability, lower limb muscle strength, and postoperative delirium. METHODS: This was a retrospective observational study performed at Kobe City Medical Center General Hospital. Patients who underwent surgery at the Kobe City Medical Center General Hospital Cardiovascular Surgery from August 1, 2016 to July 31, 2017 were included. Preoperative physical functions were obtained. Those showing positive results using the confusion assessment method for intensive care unit (ICU) during the ICU stay were considered as the delirium group, and the postoperative and non-postoperative delirium groups were compared. A multiple logistic regression analysis was performed with the presence or absence of onset of delirium as the dependent variable and the SPPB total score and age as dependent variables. RESULTS: There were 193 subjects in this study (120 males and 73 females). Sixteen patients (8.4 %) had postoperative delirium. The age in the postoperative delirium group was significantly higher than in the postoperative delirium group (77.8 (7.0) years vs. 70.0 (11.1) years). BMI and SPPB total score were significantly lower in the postoperative delirium group. From the multiple logistic regression, the SPPB total score (OR: 0.754, 95 % CI: 0.643-0.883, p < 0.001) was extracted as a factor related to postoperative delirium onset. CONCLUSION: It was illuminated that in patients with cardiovascular surgery, preoperative low physical function was not affected by age and became a risk factor of postoperative delirium onset.

Alterations in deep tissue temperature around the knee after total knee arthroplasty: its association with knee motion recovery in the early phase.

PURPOSE: Cryotherapy has been employed to reduce postoperative inflammation for enhancement of the recovery of total knee arthroplasty (TKA). However, the clinical advantages in functional recovery after TKA remain controversial. This study was conducted to clarify the postoperative alterations in deep temperature around the knee and to evaluate the association between the temperature changes and functional recovery in the early phase after TKA. METHODS: Postoperative changes in deep temperature around the knee were evaluated with the probe that can measure subcutaneous tissue temperature at the depth of 1 cm in 28 patients with medial knee osteoarthritis undergoing unilateral TKA through medial parapatellar approach. The same rehabilitation protocol was provided without cryotherapy. Outcome assessment included knee range of motion (ROM) and 10-meter fast speed walking test. RESULTS: The operated knee showed a greater increase in deep temperature at postoperative days 1 and 2, followed by a gradual decrease by day 14 when the temperature was still higher than the baseline. When deep temperature change around the operated knee was calculated by subtracting the preoperative temperature from the highest postoperative one, significant association was found between deep temperature change and knee ROM recovery at day 14. The operated knees with more than 2°C increase in postoperative deep temperature resulted in poor ROM recovery. There was no association of deep temperature change with 10-meter fast speed walking test improvement at day 14 or ROM recovery at 1-year follow-up. CONCLUSIONS: This study has provided the first data on deep temperature alterations around the knee after TKA. More than 2°C increase in postoperative deep temperature could result in poor ROM recovery after TKA. The results may support establishment of adequate procedures of cryotherapy for early gain in knee motion after TKA.

Sex-specific Outcomes and Predictors of Concussion Recovery.

INTRODUCTION: Sports-related concussion (SRC) is a substantial concern in collegiate athletics. Some studies of SRC that make comparisons by sex are limited by sample size, follow-up duration, or referral bias. Sex-specific predictors of occurrence and recovery are uncertain. METHODS: A 15-year retrospective cohort study identified 1,200 Columbia University varsity athletes (822 male [68.5%], 378 female [31.5%]) at risk of collegiate SRC. RESULTS: A total of 228 athletes experienced at least one collegiate concussion, including 88 female athletes (23.3% of female athletes) and 140 male athletes (17.0% of male athletes) (P = 0.01); follow-up data were available on 97.8% of these athletes. Postconcussion symptoms were similar by sex, with the exception of sleep disturbance (29.3% of male athletes versus 42.0% of female athletes; P = 0.048) and memory impairment (43.6% of male athletes versus 30.7% of female athletes; P = 0.052), although the latter difference was not statistically significant. Risk factors for collegiate concussion included female sex (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1 to 2.0) or precollegiate concussion (OR, 2.9; 95% CI, 2.2 to 3.9). Prolonged recovery was predicted by the presence of eight or more postconcussion symptoms for all athletes (OR, 3.77; 95% CI, 1.68 to 8.46) and for female athletes only (OR, 8.24; 95% CI, 1.58 to 43.0); this finding was not statistically significant for male athletes. DISCUSSION: Female athletes were more likely than male athletes to experience concussion. Increasing numbers of prior concussions predicted recurrence. Although most postconcussion symptoms were highly intercorrelated, the total number of symptoms predicted a prolonged recovery period. CONCLUSION: This study confirms sex-based differences in SRCs. Longitudinal studies of collegiate cohorts should attempt to limit follow-up bias and offer opportunities to clarify determinants of SRC.