[Novel therapies in respiratory management]. / Pneumologie.

In this review of the recent medical literature, we have identified 4 topics of interest for the readers of Revue Médicale Suisse. Use of antifibrotic drugs in interstitial lung diseases will soon be extended to a phenotype labeled « progressive fibrosing interstitial lung disease ¼ (PF-ILD). While awaiting for evidence-based treatment, consensual recommendations for a treatment algorithm in pulmonary sarcoidosis has been published. New guidance for non-invasive ventilation in COPD and obesity-hypoventilation syndrome are available in Switzerland and are in line with international recommendations. New treatments targeting CFTR protein activity have become available and could become a therapeutic option for up to 85% of cystic fibrosis patients in Switzerland.

Dans cette revue de la littérature médicale récente, nous avons identifié quatre sujets d'intérêts pour les lecteurs de la Revue Médicale Suisse. L'utilisation de médicaments antifibrotiques dans les maladies pulmonaires interstitielles sera bientôt étendue à un phénotype étiqueté « maladie pulmonaire interstitielle fibrosante progressive ¼. Des recommandations consensuelles pour un algorithme de traitement dans la sarcoïdose pulmonaire ont été publiées. De nouvelles directives pour la ventilation non invasive dans la BPCO et le syndrome d'obésité-hypoventilation sont disponibles en Suisse et sont conformes aux recommandations internationales. De nouveaux traitements ciblant l'activité protéique CFTR (Cystic Fibrosic Transmembrane Conductance Regulator) sont disponibles et pourraient devenir une option thérapeutique pour 85 % des patients atteints de mucoviscidose en Suisse.

[Oxygen toxicity in acute care settings]. / Toxicité de l'oxygène dans les soins aigus.

Oxygen therapy is widespread in acute care settings as adequate oxygen supplementation is essential in case of hypoxemia. Excessive oxygen supplementation has several unrecognized deleterious effects. This article reviews the deleterious effects of hyperoxemia and sums up the actual recommendations for safe oxygen supplementation.

L'administration libérale d'oxygène dans les soins aigus est fréquente, mais n'est pas anodine. En cas d'hypoxémie, elle est bien sûr indispensable, mais son utilisation abusive peut résulter en une hyperoxie, avec de nombreux effets secondaires. Cet article résume les principes de l'oxygénothérapie ainsi que les effets néfastes provoqués par l'hyperoxie qui sont souvent méconnus.

[Ultrasound in the emergency department as an extension of the practitioner's clinical examination]. / L'échographie comme prolongement de l'examen clinique du praticien.

Ultrasound in the emergency department and general practice can be used as an extension of the physical examination, answering simple questions. It requires a short basic training that is easily accessible. This article illustrates with a few examples (kidney, lung and fractures) the interest of this formidable tool becoming unavoidable in the emergency department and general practice.

L'échographie aux urgences et en médecine de premier recours peut être utilisée comme un prolongement de l'examen clinique, permettant d'apporter des réponses à des questions simples. Elle nécessite une courte formation de base qui est actuellement facilement accessible. Cet article illustre à travers quelques exemples (rein, poumon et fractures) l'intérêt de ce formidable outil, amené à devenir incontournable aux urgences et au cabinet du généraliste.

Virtual reality intervention alleviates dyspnoea in patients recovering from COVID-19 pneumonia.

Background: Immersive virtual reality (iVR)-based digital therapeutics are gaining clinical attention in the field of pain management. Based on known analogies between pain and dyspnoea, we investigated the effects of visual respiratory feedback on persistent dyspnoea in patients recovering from coronavirus disease 2019 (COVID-19) pneumonia. Methods: We performed a controlled, randomised, single-blind, crossover proof-of-concept study (feasibility and initial clinical efficacy) to evaluate an iVR-based intervention to alleviate dyspnoea in patients recovering from COVID-19 pneumonia. Included patients reported persistent dyspnoea (≥5 on a 10-point scale) and preserved cognitive function (Montreal Cognitive Assessment score >24). Assignment was random and concealed. Patients received synchronous (intervention) or asynchronous (control) feedback of their breathing, embodied via a gender-matched virtual body. The virtual body flashed in a waxing and waning visual effect that could be synchronous or asynchronous to the patient's respiratory movements. Outcomes were assessed using questionnaires and breathing recordings. Results: Study enrolment was open between November 2020 and April 2021. 26 patients were enrolled (27% women; median age 55 years, interquartile range (IQR) 18 years). Data were available for 24 of 26 patients. The median rating on a 7-point Likert scale of breathing comfort improved from 1 (IQR 2) at baseline to 2 (IQR 1) for synchronous feedback, but remained unchanged at 1 (IQR 1.5) for asynchronous feedback (p<0.05 between iVR conditions). Moreover, 91.2% of all patients were satisfied with the intervention (p<0.0001) and 66.7% perceived it as beneficial for their breathing (p<0.05). Conclusion: Our iVR-based digital therapy presents a feasible and safe respiratory rehabilitation tool that improves breathing comfort in patients recovering from COVID-19 infection presenting with persistent dyspnoea. Future research should investigate the intervention's generalisability to persistent dyspnoea with other aetiologies and its potential for preventing chronification.

Secular changes of spinal canal dimensions in Western Switzerland: a narrowing epidemic?

STUDY DESIGN: Computed tomography-based anatomical study. OBJECTIVE: To study the secular changes in lumbar spinal canal dimensions. SUMMARY OF BACKGROUND DATA: Development of symptomatic lumbar spinal stenosis, among other factors, is related to the dimensions of the bony canal. The canal reaches its adult size early on in life. Several factors, including protein intake, may influence its final dimensions. As with increases in human stature from improvements of socioeconomic conditions, we hypothesized that adult bony canal size has also grown larger in recent generations. METHODS: This study analyzes computed tomographic reconstructions from 184 subjects performed for either trauma (n = 81) or abdominal pathologies (n = 103) and born either between 1940 and 1949 (n = 88) or 1970 and 1979 (n = 96). The cross-sectional area of the bony canal was digitally measured at the level of the pedicle (i.e., at a level not influenced by degenerative changes) for each lumbar vertebra. Intra- and interobserver reliability was assessed. RESULTS: Intra- and interobserver measurement reliability were excellent (interclass correlation coefficient = 0.87) and good (interclass correlation coefficient = 0.61), respectively. Contrary to our hypothesis, the 1940-1949 generation patient group exhibited larger lumbar canals at all levels as compared with the 1970-1979 group. Statistically this difference was highly significant (P < 0.001) and particularly pronounced in the trauma subgroup. CONCLUSION: Given that human stature evolution has stabilized and adult height is established during the first 2 years of long bone growth, it is possible that antenatal factors are responsible for this surprising finding. Maternal smoking and age may be possible explanations. This finding may have significant implications. An increasing number of patients may emerge with lumbar spinal stenosis as degenerative changes develop, putting a strain on health resources. Further studies in different population groups and countries will be important to further confirm this trend. LEVEL OF EVIDENCE: 3.