[Physiotherapy and COVID-19. From intensive care unit to home care-An overview of international guidelines]. / Kinésithérapie et COVID-19 : de la réanimation à la réhabilitation à domicile. Synthèse des recommandations internationales.

INTRODUCTION: The new coronavirus disease 2019 (COVID-19) is responsible for a global pandemic and many deaths. This context requires an adaptation of health systems as well as the role of each healthcare professional, including physiotherapists. STATE OF THE ART: In order to optimize the management of people with COVID-19, many savant societies published guidelines about physiotherapy interventions within the crisis but none offered a global overview from the intensive care unit to home care. Therefore, the aim of this review is to offer an overview of recommended physiotherapy interventions in order to facilitate the management of these patients, whatever the stage of the disease. PERSPECTIVES: Owing to the emergent character of the COVID-19, actual guidelines will have to be adjusted according to the evolution of the pandemic and the resources of the hospital and liberal sectors, in particular for the long-term follow-up of these patients. Current and future research will aim to assess the effectiveness of physiotherapy interventions for people with COVID-19. CONCLUSION: The emergence of COVID-19 required a very rapid adaptation of the health system. The role of physiotherapists is justified at every stage of patients care in order to limit the functional consequences of the disease.

[Cohort of patients initiated to home ventilation. Observational and prospective study]. / Cohorte de patients nouvellement traités par ventilation non invasive à domicile. Étude observationnelle, prospective et multicentrique.

Cohort of patients initiated to home ventilation. Observational and prospective study. The effectiveness of home noninvasive ventilation (NIV) for chronic respiratory failure (CRF) is well established. However, few data are available about home NIV prescription and utilization according to the different etiologies of respiratory failure. The ANTADIR Federation, in partnership with the Ventilatory Support Group of the French Speaking Pulmonary Society, has set up a national, observational and multicenter cohort study. The main goal of this study is to analyze the clinical data justifying home NIV prescription in patients with chronic respiratory insufficiency. The secondary objectives will be to assess: the evolution of comorbidities or their occurrence, hospitalizations, NIV compliance, dropout and survival. The population includes patients with chronic respiratory failure newly initiated onto NIV, both in a stable state and following an acute exacerbation who qualify for long-term NIV. Data collected include: diagnosis and comorbidities, age, sex, BMI, biomarkers (hematocrit, arterial blood gases, total CO2) and functional data (FEV1, VC, TLC), nocturnal results (SaO2, PtcCO2), type of ventilator used, ventilator parameters and mask type. Follow-up data will be collected at 4 months, 1 year and 2 years and will include: hospitalizations, changes in prescription, adherence, dropouts and deaths. This work will make it possible to obtain new scientific information on long-term NIV use in France.

[Cardiopulmonary interactions in the course of mechanical ventilation]. / Interactions cœur­poumons au cours de la ventilation mécanique.

INTRODUCTION: The haemodynamic consequences of ventilation are multiple and complex and may affect all the determinants of cardiac performance such as heart rate, preload, contractility and afterload. These consequences affect both right and left ventricle and are also related to the biventricular interdependence. STATE-OF-THE-ART: Ventilation modifies the lung volume and also the intrathoracic pressure. Variations in lung volume have consequences on the pulmonary vascular resistance, hypoxic pulmonary vasoconstriction and ventricular interdependence. Variations in intrathoracic pressure have a major impact and affect systemic venous return, right ventricular preload, left ventricular preload, right ventricular afterload, left ventricular afterload and myocardial contracility. The haemodynamic consequences of positive pressure ventilation depend on the underlying chronic cardiopulmonary pathologies leading to the acute respiratory failure that was the indication for ventilation. CONCLUSION: In this review, we will focus on severe COPD exacerbation, acute left heart failure and weaning from ventilation.

[Noninvasive ventilation during pulmonary rehabilitation in COPD patients]. / Ventilation non invasive au cours de la réhabilitation respiratoire des patients atteints de BPCO.

INTRODUCTION: Pulmonary rehabilitation is currently the gold standard treatment for patients with chronic obstructive pulmonary disease (COPD). However, the workload achieved may be insufficient to obtain physiological benefits because of the restricted respiratory capacity. BACKGROUND: In patients with COPD, changes in flow as well as biomechanical factors (distension) compromise respiratory adaptation to exertion. Some studies have shown that noninvasive ventilation (NIV) during exercise has a positive effect on respiratory muscle workload, physiological parameters and perceived exertion. However the evidence remains insufficient regarding the effects of the NIV during comprehensive pulmonary rehabilitation programs. OBJECTIVES: The identification of criteria which determine responsive patients is necessary in order to reduce human and time costs and to optimize the use of NIV during exercise. CONCLUSIONS: NIV is used during training to overcome dyspnoea and to increase muscle workload. Further studies are needed to verify the effectiveness of NIV in pulmonary rehabilitation.

Medium-term cost-effectiveness of an automated non-invasive ventilation outpatient set-up versus a standard fixed level non-invasive ventilation inpatient set-up in obese patients with chronic respiratory failure: a protocol description.

INTRODUCTION: Obesity is an escalating issue, with an accompanying increase in referrals of patients with obesity-related respiratory failure. Currently, these patients are electively admitted to hospital for initiation of non-invasive ventilation (NIV), but it is unknown whether outpatient initiation is as effective as inpatient set-up. We hypothesise that outpatient set-up using an autotitrating NIV device will be more cost-effective than a nurse-led inpatient titration and set-up. METHODS AND ANALYSIS: We will undertake a multinational, multicentre randomised controlled trial. Participants will be randomised to receive the usual inpatient set-up, which will include nurse-led initiation of NIV or outpatient set-up with an automated NIV device. They will be stratified according to the trial site, gender and previous use of NIV or continuous positive airway pressure. Assuming a 10% dropout rate, a total sample of 82 patients will be required. Cost-effectiveness will be evaluated using standard treatment costs and health service utilisation as well as health-related quality of life measures (severe respiratory insufficiency (SRI) and EuroQol-5 dimensions (EQ-5D)). A change in the SRI questionnaire will be based on the analysis of covariance adjusting for the baseline measurements between the two arms of patients. ETHICS AND DISSEMINATION: This study has been approved by the Westminster National Research Ethics Committee (11/LO/0414) and is the trial registered on the UKCRN portfolio. The trial is planned to start in January 2015 with publication of the trial results in 2017. TRIAL REGISTRATION NUMBER: ISRCTN 51420481.

[Noninvasive ventilation: efficacy of a new ventilatory mode in patients with obesity-hypoventilation syndrome]. / Ventilation non invasive : efficacité d'un nouveau mode ventilatoire chez les patients atteints du syndrome obésité-hypoventilation.

Noninvasive ventilation is recommended to correct the nocturnal hypoventilation and relieve the symptoms of patients with the obesity-hypoventilation syndrome (OHS). The benefits of fixed pressure ventilation (S/T technology) are recognized but limited on account of the variability of nocturnal ventilatory requirements. The new technique AVAPS-AE (automatic EPAP) allows adjustment of the pressure according to the volume currently targeted. Its efficacy has not yet been evaluated. Our objectives are to evaluate firstly, whether AVAPS-AE optimizes the benefits of S/T technology on sleep architecture and quality, secondly, whether these benefits are associated with an improvement in gas exchange, symptoms, exercise tolerance, level of physical activity and quality of life of patients with OHS. In this multicenter trial, 60 newly diagnosed patients with OHS will be randomized to the control (S/T) and trial (AVAPS-AE) groups. A standardized titration procedure will be followed for the calibration of the ventilators. Functional evaluations (polysomnography, blood gases, impedance measurements and walking tests), questionnaires (physical activity, quality of life, quality of sleep and daytime somnolence) visual scales (fatigue, headaches) and a recording of activity will be undertaken after two months of ventilation.

[A comparison of pulmonary rehabilitation delivered in the home or at a centre for patients with COPD]. / Comparaison de la réhabilitation respiratoire de patients atteints de BPCO en centre et à domicile.

AIM: There are few data showing how pulmonary rehabilitation (PR) for COPD patients carried out at home impacts on health-related quality of life (HRQL). The aim of this study was to determine if PR conducted at home improves quality of life. METHODS: We compared the results of home-based PR versus PR performed in an outpatient center. The outcomes were the HRQL measured by the Saint-George's Hospital questionnaire and the 6-minute walk test distance (6MWT). Fifty-six COPD patients were included for PR either at home (n=27) or in the outpatient center (n=29) depending on distance from the center and patients preference. The two groups were similar for sex, age, BMI, lung function, and initial peak oxygen uptake. RESULTS: 6MWT showed a similar non-significant improvement in both groups after PR (+12±46m in home-based PR,+13±34m in outpatient center). HRQL was significantly improved in the home-based group in 2 domains : "Activity" (-8.6±6.4 vs -0.7±17.7, P<0.05), "Impact" (-8.4±6.5 vs 1.6±11.7, P<0.001) and total score (-8.2±4.0 vs 0.0±8.8, P<0.001). CONCLUSION: Pulmonary rehabilitation at home is associated with improvements in health-related quality of life, and thus can be considered where availability of treatment in specialized centers is limited.

[Assessment of recent weight history before instituting continuous positive airways pressure in a cohort of patients with severe obstructive sleep apnoea/hypopnea syndrome]. / Histoire pondérale récente, avant l'institution de la pression positive continue, dans une cohorte de patients ayant un syndrome d'apnées-hypopnées obstructives du sommeil sévère.

OBJECTIVES: The aim of this study is to evaluate the recent weight history in patients with the obstructive sleep apnoea/hypopnoea syndrome (OSAHS) needing treatment with continuous positive airways pressure (CPAP). PATIENTS AND METHODS: Over a period of 18 months, a self-administered questionnaire concerning recent weight history was given to patients during the installation of CPAP. RESULTS: The study population consisted of 1337 patients. An increase in weight of at least 5% over the 5 years preceding the institution of CPAP was found in 44% of patients. This increase was moderate (5-10%), important (10-20%) and very important (>20%) in respectively 12.3%, 16.1% and 15.6% of patients. The patients with important or very important weight gain differed from those whose weight remained steady in a higher percentage of women, young people, and patients with a higher prevalence of obesity, persistent smoking, a history of venous thromboembolism and treatment with anti-depressants. CONCLUSION: A recent increase in weight is frequently seen in severe OSAHS and is associated with some clinical characteristics.

[Acute respiratory failure due to Mycoplasma pneumonia]. / Détresse respiratoire aiguë due à Mycoplasma pneumoniae.

INTRODUCTION: Respiratory infections due to Mycoplasma pneumoniae are typically mild and subacute. We report the case of a 40-year-old man hospitalized for acute respiratory distress in the context of an acute infection with Mycoplasma pneumoniae. Radiological and pulmonary function test were consistent with an acute infectious bronchiolitis. CASE REPORT: The patient presented with isolated respiratory failure with profound hypoxemia requiring oxygen delivered at high concentration by face mask. The CT appearance of the lesions corresponded to a spread of bilateral micro-connected pulmonary nodules (a "tree-in-bud" pattern) associated with obstructive ventilatory disorder. The only pathogen identified by PCR on BAL and serology was Mycoplasma pneumoniae. The evolution was favorable with antibiotic therapy combined with corticosteroids. CONCLUSION: Mycoplasma pneumoniae may be responsible for severe respiratory illness in the form of bronchiolitis. In the setting of severe acute community pneumoniae antibiotic treatment which is also effective against Mycoplasma pneumonia should be considered. In this case, corticosteroids may be an effective adjunct by their action on the small airways.

[A multi-centre randomized controlled trial of domiciliary non-invasive ventilation vs long-term oxygen therapy in survivors of acute hypercapnic respiratory failure due to COPD. Non-invasive ventilation in obstructive lung disease (NIVOLD) study]. / Bénéfices de la ventilation non invasive à domicile au décours d'une insuffisance respiratoire aiguë hypercapnique chez les patients BPCO. Étude contrôlée randomisée multicentrique. Étude Non Invasive Ventilation in Obstructive Lung Disease (Nivold).

BACKGROUND: Patients with chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD) are very likely to develop acute exacerbations. Non-invasive ventilation is often used to treat acute respiratory failure but little information is available about the benefits of domiciliary non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure who survive an acute episode. The purpose of this study is to determine whether domiciliary non-invasive ventilation can reduce the incidence of recurrent acute hypercapnic respiratory failure in COPD patients who survived an episode of acute hypercapnic respiratory failure (AHRF). METHODS: A multi-center randomized controlled trial including patients with COPD who survived an episode of AHRF. Patients will be randomly assigned to receive long-term oxygen therapy (LTOT) (no intervention) or domiciliary non-invasive ventilation (active comparator) in addition to LTOT. In France, three university hospitals: Rouen, Caen and Amiens and three general hospitals: Dieppe, Le Havre and Elbeuf are recruiting. INCLUSION CRITERIA: Age above 18 years; patients with COPD who have survived an episode of AHRF; patients weaned from non-invasive or mechanical ventilation for at least seven days following an acute episode; with stable arterial blood gases for at least two days: PaCO(2) greater than 55mmHg and pH greater than 7.35. Exclusion criteria are: age above 85 years, other causes of respiratory failure, obstructive sleep apnoea, adverse psychosocial status, serious co-morbidity. Primary outcome is the frequency of episodes of acute hypercapnic respiratory failure (time frame: up to 102 weeks), secondary outcome is mortality (time frame: 1 month and every 6 months for 2 years). EXPECTED RESULTS: A decreased rate of episodes of acute hypercapnic respiratory failure in the group of patients receiving non-invasive ventilation in addition to long term oxygen therapy.

[Non-invasive ventilation era: is there still a place for long-term tracheostomy?]. / Place de la trachéotomie au long cours dans l'insuffisance respiratoire chronique sévère à l'ère de la ventilation non invasive.

INTRODUCTION: At a time when non-invasive ventilation (NIV) is commonly used in acute as well as chronic respiratory failure, it is important to consider the current place, if any, of long-term tracheostomy. BACKGROUND: Except in emergency situations where tracheostomy is mandatory to ensure safe access to the airway, long-term ventilation with tracheostomy (LTVT) is generally considered in the case of inability to wean from NIV after an episode of acute respiratory failure requiring endotracheal ventilation or because of the development of bulbar signs (swallowing, phonation) in advanced neuromuscular disease. It is also appropriate when ventilatory dependence on NIV exceeds 20 hours per day. Historical retrospective studies confirmed the feasibility of LTVT, but this has to be seen in perspective with the results obtained 20 years later with NIV. VIEWPOINT AND CONCLUSION: Even if the indications for LTVT have diminished considerably since the emergence of NIV, tracheostomy remains mandatory in some situations of respiratory distress and it should be considered as a potential resource, possibly temporary in some cases in the light of recent work on the possibility of decanulation after LTVT.

[Mature mediastinal teratoma and sarcoid-like granulomatosis]. / Tératome mature médiastinal et granulomatose sarcoid-like.

INTRODUCTION: Sarcoidosis is a systemic granulomatous disorder. However, when epithelioid cell granulomata are found in association with malignancy, they could correspond to a sarcoid reaction. CASE REPORT: We report the case of a young woman with mediastinal lymphadenopathy containing non-caseating granulomata. She also had a mass in the anterior mediastinum which proved, on surgical resection, to be an intrathymic mature teratoma. CONCLUSION: An association between a sarcoid-like reaction and testicular germ cell tumours has been described in literature. Our observation of a sarcoid reaction associated with a teratoma could be due to a hypersensitivity reaction to antigen released by the tumour.

[The French translation and cultural adaptation of the SRI questionnaire. A questionnaire to assess health-related quality of life in patients with chronic respiratory failure and domiciliary ventilation]. / Traduction française et adaptation culturelle du questionnaire SRI. Questionnaire de qualité de vie liée à la santé des patients insuffisants respiratoires chroniques traités par ventilation à domicile.

INTRODUCTION: We performed the French translation and cross-cultural adaptation of the Severe Respiratory Insufficiency (SRI) questionnaire. Written and validated in German, this questionnaire evaluates health-related quality of life in patients treated with domiciliary ventilation for chronic respiratory failure. METHODS: Four bilingual German-French translators and a linguist were recruited to produce translations and back-translations of the questionnaire constituted of 49 items in seven domains. Two successive versions were generated and compared to the original questionnaire. The difficulty of the translation and the naturalness were quantified for each item using a 1-10 scale and their equivalence to their original counterpart was graded from A to C. The translated questionnaire was finally tested in a pilot study, which included 15 representative patients. RESULTS: The difficulty of the first translation and the first back-translation was respectively quantified as 2.5 (range 1-5.5) and 1.5 (range 1-6) on the 10-point scale (P=0.0014). The naturalness and the equivalence of 8/49 items were considered as insufficient, which led to the production of a second translation and a second back-translation. The meanings of two items needed clarification during the pilot study. CONCLUSION: The French translation of the SRI questionnaire represents a new instrument for clinical research in patients treated with domiciliary ventilation for chronic respiratory failure. Its validity needs to be tested in a multicenter study.

[Home telemonitoring of CPAP: a feasibility study]. / La télé-observance à domicile de la pression positive continue: étude de faisabilité.

BACKGROUND: The most commonly used treatment for the sleep apnoea syndrome (SAS) is the application of constant positive airway pressure (CPAP) during sleep. Compliance is an essential element in the efficiency of CPAP. This is dependent on the quality of the management of care and on the education of the patients. With the emergence of telemedicine, telemonitoring of CPAP has been developed in France. METHODS: This study will be observational and multicentered. The main aim is to evaluate the feasibility of CPAP telemonitoring in SAS patients (n=90). During the installation of the equipment, the patients will be instructed how to connect the CPAP Secure Digital card to a data transmitting box every week for two months. The actual number and frequency of remote-monitoring box connections will be recorded. The data transmission will be made to the study coordinator, the home care provider SADIR, by the way of a telemedicine platform, located in France. EXPECTED RESULTS: This study will allow measurement of the adherence of the patients to their CPAP treatment by telemonitoring using this new tool of data transmission and the impact of this on CPAP compliance.

Beyond corticosteroids: future prospects in the management of inflammation in COPD.

Inflammation plays a central role in the pathophysiology of chronic obstructive pulmonary disease (COPD). Exposure to cigarette smoke induces the recruitment of inflammatory cells in the airways and stimulates innate and adaptive immune mechanisms. Airway inflammation is involved in increased bronchial wall thickness, increased bronchial smooth muscle tone, mucus hypersecretion and loss of parenchymal elastic structures. Oxidative stress impairs tissue integrity, accelerates lung ageing and reduces the efficacy of corticosteroids by decreasing levels of histone deacetylase-2. Protease-antiprotease imbalance impairs tissues and is involved in inflammatory processes. Inflammation is also present in the pulmonary artery wall and at the systemic level in COPD patients, and may be involved in COPD-associated comorbidities. Proximal airways inflammation contributes to symptoms of chronic bronchitis while distal and parenchymal inflammation relates to airflow obstruction, emphysema and hyperinflation. Basal levels of airways and systemic inflammation are increased in frequent exacerbators. Inhaled corticosteroids are much less effective in COPD than in asthma, which relates to the intrinsically poor reversibility of COPD-related airflow obstruction and to molecular mechanisms of resistance relating to oxidative stress. Ongoing research aims at developing new drugs targeting more intimately COPD-specific mechanisms of inflammation, hypersecretion and tissue destruction and repair. Among new anti-inflammatory agents, phosphodiesterase-4 inhibitors have been the first to emerge.