[Hypercapnic failure in patients with COPD under 4 weeks non-invasive, home mechanical ventilation]. / Rekompensation von schwerem hyperkapnischem Versagen bei Patienten mit COPD unter 4 Wochen intermittierender nicht invasiver Heimbeatmung.

BACKGROUND: In patients with severe COPD, ventilatory pump failure is a separate pathophysiological factor. Non-invasive ventilatory support has been introduced in COPD with acute-on-chronic respiratory failure according to evidence-based medicine, but the benefit of long-term ventilation is still not proven. The purpose of this investigation was to evaluate the feasibility of carbon dioxide-reducing, non-invasive, home mechanical ventilation in patients with chronic hypercapnic respiratory failure due to stable COPD. METHODS: In 40 patients (median age 72.2/61.1 - 78.1 years), with chronic ventilatory failure due to COPD who received non-invasive, home mechanical ventilation (NIV) successfully we analysed blood gases, lung function, 6-minute walking distance and quality of life before NPPV and after a period of at least 4 weeks of home therapy. RESULTS: Successful home mechanical ventilation could be proven by a significant decrease of hypercapnia during spontaneous breathing: 8.5 kPa (64.6 mmHg) before NIV to 5.9 kPa (45.2 mm Hg) during NIV. Six-minute walking distance increased significantly from 89 m to 230 m. General health perception (SF 36) improved from 27 to 56 significantly as did other quality of life categories. CONCLUSION: Although this investigation has some limitations such as lack of controls and highly selected patients, it could be proven that CO (2)-decreasing, non-invasive mechanical ventilation is feasible in terms of home therapy and effective to recompensate chronic ventilatory failure in stable COPD. Under such treatment, patients can reestablish their physical ability and report quality of life improvements.

Sleep apnoea in heart failure.

Studies from the USA have reported that sleep apnoea is common in congestive heart failure (CHF), with Cheyne-Stokes respiration (CSR) being the most frequent type of sleep-disordered breathing (SDB) in these patients. Within the present study, the authors sought to assess the prevalence and type of SDB among CHF patients in Germany. A total of 203 CHF patients participated in this prospective multicentre study. All patients were stable in New York Heart Association classes II and III and had a left ventricular ejection fraction (LVEF)<40%. The patients were investigated by polygraphy and all data were centrally analysed. Patient enrolment was irrespective of sleep-related symptoms. The majority of patients were male with a mean age of 65 yrs and hospitalised. Of the 203 patients, 145 (71%) had an apnoea/hypopnoea index>10.h(-1), obstructive sleep apnoea (OSA) occurred in 43% (n=88) and CSR in 28% (n=57) of patients. The prevalence of sleep-disordered breathing is high in patients with stable severe congestive heart failure from a European population. As sleep-disordered breathing may have a negative impact on the prognosis of congestive heart failure, a sleep study should be performed in every patient with congestive heart failure and a left ventricular ejection fraction of <40%. This diagnostic approach should probably be adopted for all of these patients irrespective of the presence of sleep-related symptoms.

[Cardiac efficiency in patients with Cheyne-Stokes respiration as a result of heart insufficiency during long-term nasal respiratory treatment with adaptive servo ventilation (AutoSet CS)]. / Kardiale Leistungsfähigkeit bei Patienten mit Cheyne-Stokes-Atmung infolge Herzinsuffizienz während langfristiger nasaler Beatmungstherapie mittels adaptiver Servoventilation (AutoSet CS).

Cheyne-Stokes respiration (CSR) is known to be an important negative predictor of outcome in patients with congestive heart failure. The goal of this study was to investigate whether the use of adaptive servo ventilation (AutoSet CS) would permit sufficient suppression of this pathological breathing pattern and improve cardiac function in longterm use over 1 year. Inclusion criteria for the study were congestive heart failure (left ventricular ejection fraction 20-50%), proven CSR with a central apnea-hypopnea index (AHI) > 15/h and stable clinical status with standard medical therapy. Patients with obstructive sleep apnea and COPD were excluded. Twenty consecutive patients (16 male) age 65.5 years (range 48-77) were followed with full blood counts, blood gas analysis, lung function tests and questionnaires for cardiopulmonary capacities (Minnesota, MRC Scale) and sleepiness (Epworth Sleepiness Scale). In addition, we performed 6-min walk distance (6MWD), echocardiography and polysomnography just before and after adjusting to adaptive servo ventilation and 3 and 12 months later. Mean usage of adaptive servo ventilation was sufficient (4.3 +/- 2.1 h/day at 12 months). No significant changes in blood gas analysis, blood counts and pulmonary function were detectable. CSR disappeared almost completely in all patients (AHI pre-study 44.3 +/- 13.4/h vs 3.4 +/- 8.0/h at 12 months; p < 0.0001). Saturation normalized steadily over the course of the study. The desaturation index decreased from 45.3 +/- 17.8/h to 5.2 +/- 11.5/h at 12 months (p < 0.0001). Mean saturation increased with the first night of sleep with adaptive servo ventilation from 92.0 +/- 2.5% to 93.0 +/- 1.6% (p < 0.05) and then to 94.1 +/- 1.9% at 3, and 94.2 +/- 1.9% at 12 months (p < 0.001). Quality of sleep was significantly improved with an increase of slow-wave sleep from 4.5 +/- 4.6% to 13.7 +/- 6.9% at 12 months (p < 0.0001). The arousal index concomitantly decreased from 29.8 +/- 17.9/h pre-study to 12.0 +/- 10.3/h at 12 months (p < 0.01). REM-sleep and sleep efficiency remained unchanged. The Epworth Sleepiness Scale showed only a trend to improvement. Cardiac function improved significantly during the course of the study. The ejection fraction increased from mean 37.1 +/- 12.5% pre-study to 41.7 +/- 8.8% at 12 months (p < 0.05). The 6-min walk distance increased from 192 +/- 110 m to 277 +/- 130 m at 12 months (p < 0.01). The MRC and Minnesota score were not significantly different pre- and post-study. We conclude that long-term respirator therapy with adaptive servo ventilation has sufficiently suppressed CSR and improved cardiac function in patients with congestive heart failure. Thus, safety and feasibility of this respirator therapy could be demonstrated. However, due to methodological reasons (no control group, no randomization) a direct effect on cardiac function could not be confirmed.

Electron probe microanalysis (EPMA) measurement of thin-film thickness in the nanometre range.

The thickness of thin films of platinum and nickel on fused silica and silicon substrates has been determined by EPMA using the commercial software STRATAGEM for calculation of film thickness. Film thickness ranged in the order 10 nm. An attempt was made to estimate the confidence range of the method by comparison with results from other methods of analysis. The data show that in addition to the uncertainty of the spectral intensity measurement and the complicated fitting routine, systematic deviation caused by the underlying model should be added. The scattering in the results from other methods does not enable specification of a range of uncertainty, but deviations from the real thickness are estimated to be less than 20%.

Combination Chemotherapy with Docetaxel and Carboplatin for Advanced Non-Small Cell Lung Cancer.

BACKGROUND: Docetaxel has shown promising single-agent activity in non-small cell lung cancer (NSCLC) and its activity can be enhanced by the addition of platinum compounds. Several studies indicate that carboplatin may be as effective as cisplatin but with better tolerability. OBJECTIVE: A phase II study was performed to investigate the safety and efficacy of combination chemotherapy with docetaxel and carboplatin in patients with advanced NSCLC. PATIENTS AND METHODS: 30 chemotherapy-naïve patients with stage IIIB and IV NSCLC were treated with docetaxel 90 mg/m(2) over 1 hour, followed by carboplatin administered according to a target area under the curve of 5 mg/ml/min (Calvert's formula). Treatment was repeated every 3 weeks for 6 cycles. RESULTS: Myelosuppression was the predominant toxicity. Grade 3 or 4 granulocytopenia occurred in 77% of the patients. However, granulocyte colony-stimulating factor (G-CSF) was not utilised and neutropenic fever did not occur. Grade 3 or 4 nail disorder developed in 27% of the patients. Other non-haematological toxicities, including fluid retention, were mild to moderate. The objective response rate was 30% (two complete and seven partial responses). The median time to progression was 24 weeks and median survival 57 weeks. One-year survival was 56%. CONCLUSIONS: The combination of docetaxel and carboplatin appears to be well tolerated and active in patients with advanced NSCLC.