Continuously monitored vital signs for detection of myocardial injury in high-risk patients - An observational study.

BACKGROUND: Patients are at risk of myocardial injury after major non-cardiac surgery and during acute illness. Myocardial injury is associated with mortality, but often asymptomatic and currently detected through intermittent cardiac biomarker screening. This delays diagnosis, where vital signs deviations may serve as a proxy for early signs of myocardial injury. This study aimed to assess the association between continuous monitored vital sign deviations and subsequent myocardial injury following major abdominal cancer surgery and during acute exacerbation of chronic obstructive pulmonary disease. METHODS: Patients undergoing major abdominal cancer surgery or admitted with acute exacerbation of chronic obstructive pulmonary disease had daily troponin measurements. Continuous wireless monitoring of several vital signs was performed for up to 96 h after admission or surgery. The primary exposure was cumulative duration of peripheral oxygen saturation (SpO2 ) below 85% in the 24 h before the primary outcome of myocardial injury, defined as a new onset ischaemic troponin elevation assessed daily. If no myocardial injury occurred, the primary exposure was based on the first 24 h of measurement. RESULTS: A total of 662 patients were continuously monitored and 113 (17%) had a myocardial injury. Cumulative duration of SpO2  < 85% was significantly associated with myocardial injury (mean difference 14.2 min [95% confidence interval -4.7 to 33.1 min]; p = .005). Durations of hypoxaemia (SpO2  < 88% and SpO2  < 80%), tachycardia (HR > 110 bpm and HR > 130 bpm) and tachypnoea (RR > 24 min-1 and RR > 30 min-1 ) were also significantly associated with myocardial injury (p < .04, for all). CONCLUSION: Duration of severely low SpO2 detected by continuous wireless monitoring is significantly associated with myocardial injury in high-risk patients admitted to hospital wards. The effect of early detection and interventions should be assessed next.

Evaluation of double lung point sign as a marker for transient tachypnoea of the newborn in preterm.

Purpose: The study was conducted to diagnose transient tachypnoea of the newborn (TTN) in the early stage using ultrasonography and to estimate the sensitivity and specificity of double lung point (DLP) sign in diagnosing TTN. Material and methods: The study population included premature neonates with respiratory distress, admitted in the neonatal intensive care unit from December 2017 to June 2019, who fulfilled the inclusion criteria. A total of 100 patients were included in the study, and they underwent lung ultrasonography within 6 hours of birth. Inclusion criteria were as follows: preterm babies born < 37 weeks of gestation presenting with respiratory distress within 6 hours, clinically diagnosed with TTN and other causes like respiratory distress syndrome and pneumonia. Term neonates and neonates with congenital malformations and trauma were excluded from the study. Preterms with respiratory distress were enrolled in the study. Based on the clinical findings and laboratory investigations, clinical diagnosis was made by the paediatrician. After obtaining informed consent, ultrasonography of bilateral chest was performed using a Philips HD7 XE and a Sonoscape S2 portable ultrasound machine with a linear transducer (6-12 MHz) within 6 hours of birth. Results: The mean gestational age was 33.0 ± 1.9 weeks. Double lung point sign was present in 55 preterm neonates in our study. It was most common in bilateral posterior lung fields. The sensitivity and specificity of DLP in diagnosing TTN was 85% and 100%, respectively. Conclusions: It was found in our study that double lung point sign is the primary ultrasonographic characteristic of TTN, and ultrasonography can almost accurately diagnose TTN in early stages.

Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry.

OBJECTIVES: A recent discussion surrounding the extension of antenatal corticosteroid (ACS) use beyond 34 weeks of gestation did not include the subgroup of infants of diabetic mothers (IDM). We aimed to examine the association between ACS exposure and outcomes in neonates born at term and at near-term gestation in a large cohort of IDMs. METHODS: We selected 13976 eligible near-term and term infants who were included in the PEARL-Peristat Perinatal Registry Study (PPS). We assessed the association of ACS exposure with neonatal outcomes in a multivariate regression model that controlled for diabetes mellitus (DM) and other perinatal variables. RESULTS: The incidence of DM was 28% (3,895 of 13,976) in the cohort. Caesarean section was performed in one-third of the study population. The incidence of ACS exposure was low (1.8%) and typically occurred>2 weeks before delivery. The incidence rates of respiratory distress syndrome (RDS)/ transient tachypnoea of newborns (TTN), all-cause neonatal intensive care unit (NICU) admissions, NICU admissions for hypoglycaemia, and low 5-min Apgar scores were 3.5, 8.8, 1.3, and 0.1%, respectively. In a multivariate regression model, ACS was associated with a slight increase in NICU admissions (OR: 1.44; 95% CI: 1.04-2.03; p=0.028), but not with RDS/TTN. CONCLUSIONS: Although the low exposure rate was a limitation, ACS administration did not reduce respiratory morbidity in near-term or term IDMs. It was independently associated with an increase in NICU admissions. Randomized controlled trials are required to assess the efficacy and safety of ACS administration in diabetic mothers at late gestation.

Ventilatory constraints influence physiological dead space in heart failure.

NEW FINDINGS: What is the central question of this study? The goal of this study was to investigate the effect of alterations in tidal volume and alveolar volume on the elevated physiological dead space and the contribution of ventilatory constraints thereof in heart failure patients during submaximal exercise. What is the main finding and its importance? We found that physiological dead space was elevated in heart failure via reduced tidal volume and alveolar volume. Furthermore, the degree of ventilatory constraints was associated with physiological dead space and alveolar volume. ABSTRACT: Patients who have heart failure with reduced ejection fraction (HFrEF) exhibit impaired ventilatory efficiency [i.e. greater ventilatory equivalent for carbon dioxide ( V ̇ E / V ̇ C O 2 ) slope] and elevated physiological dead space (VD /VT ). However, the impact of breathing strategy on VD /VT during submaximal exercise in HFrEF is unclear. The HFrEF (n = 9) and control (CTL, n = 9) participants performed constant-load cycling exercise at similar ventilation ( V ̇ E ). Inspiratory capacity, operating lung volumes and arterial blood gases were measured during submaximal exercise. Arterial blood gases were used to derive VD /VT , alveolar volume, dead space volume, alveolar ventilation and dead space ventilation. During submaximal exercise, HFrEF patients had greater V ̇ E / V ̇ C O 2 slope and VD /VT than CTL subjects (P = 0.01). At similar V ̇ E , HFrEF patients had smaller tidal volumes and alveolar volumes (HFrEF 1.11 ± 0.33 litres versus CTL 1.66 ± 0.37 litres; both P ≤ 0.01), whereas dead space volume was not different (P = 0.47). The augmented breathing frequency in HFrEF patients resulted in greater dead space ventilation compared with CTL subjects (HFrEF 15 ± 4 l min-1 versus CTL 10 ± 5 l min-1 ; P = 0.048). The HFrEF patients exhibited greater increases in expiratory reserve volume and lower inspiratory capacity (as a percentage of predicted) than CTL subjects (both P < 0.05), which were significantly related to VD /VT and alveolar volume in HFrEF patients (all P < 0.03). In HFrEF, the reduced tidal volume and alveolar volume elevate physiological dead space during submaximal exercise, which is worsened in those with the greatest ventilatory constraints. These findings highlight the negative consequences of ventilatory constraints on physiological dead space during submaximal exercise in HFrEF.

Timing of elective pre-labour caesarean section: A decision analysis.

BACKGROUND: Since caesarean sections (CSs) before 39+0  weeks gestation are associated with higher rates of neonatal respiratory morbidity, it is recommended to delay elective CSs until 39+0  weeks. However, this bears the risk of earlier spontaneous labour resulting in unplanned CSs, which has workforce and resource implications, specifically in smaller obstetric units. AIM: To assess, in a policy of elective CSs from 39+0  weeks onward, the number of unplanned CSs to prevent one neonate with respiratory complications, as compared to early elective CS. MATERIALS AND METHODS: We performed a decision analysis comparing early term elective CS at 37+0-6 or 38+0-6  weeks to elective prelabour CS, without strict medical indication, at 39+0-6  weeks, with earlier unplanned CS, in women with uncomplicated singleton pregnancies. We used literature data to calculate the number of unplanned CSs necessary to prevent one neonate with respiratory morbidity. RESULTS: Planning all elective CSs at 39+0-6  weeks required 10.9 unplanned CSs to prevent one neonate with respiratory morbidity, compared to planning all elective CSs at 38+0-6  weeks. Compared to planning all elective CSs at 37+0-6  weeks we needed to perform 3.3 unplanned CSs to prevent one neonate with respiratory morbidity. CONCLUSION: In a policy of planning all elective pre-labour CSs from 39+0  weeks of gestation onward, between three and 11 unplanned CSs have to be performed to prevent one neonate with respiratory morbidity. Therefore, in our opinion, fear of early term labour and workforce disutility is no argument for scheduling elective CSs <39+0  weeks.

The role of neonatal pulmonary morbidity in the longitudinal patterns of hospitalisation for respiratory infection during the first year of life.

Respiratory infections among infants constitute a major burden to health care systems in developed nations, yet the course and risk factors leading to these conditions are poorly understood. We examine the longitudinal patterns of respiratory infection hospitalisation (RIH) and how these patterns are influenced by neonatal pulmonary morbidities. We included all live births (n = 429 058) occurring in the Australian state of Queensland between January 2009 and December 2015. Data were structured so that each participant had a record (present/absent) of RIH for each month from birth to 12 months. Initially, latent class growth analysis was used to identify the trajectories of RIH adjusted for spatial-temporal factors; using the identified trajectories of RIH as outcomes, we built a multinomial logistic regression model to identify neonatal predictors of RIH trajectories. Our results indicated that a four-class solution was the best fit to the data, comprising a 'no-risk' trajectory, a 'low-risk' trajectory, an 'early-risk' trajectory and a 'chronic-risk' trajectory. Compared with the no-risk trajectory, membership in the other trajectories was predicted by a range of neonatal pulmonary morbidities, with transient tachypnoea of newborn showing a specific relationship with the early-risk group and sleep apnoea showing a specific and strong risk with the chronic-risk group. Our findings suggest the possibility of identifying neonates at risk of recurrent RIH and implementing effective intervention strategies prior to neonatal discharge.

Effect of increasing respiratory rate on airway resistance and reactance in COPD patients.

BACKGROUND AND OBJECTIVE: Airway resistance and reactance measured by forced oscillometry have been used to measure the severity of airway obstruction in chronic obstructive pulmonary disease (COPD) patients. The aims of this study were to assess the effects of tachypnoea on airway resistance and reactance and to correlate these with the severity of dyspnoea. We also evaluated the effects of short-acting ß2-agonist (SABA) on these measurements. METHODS: Airway resistance and reactance were measured with an impulse oscillation system (IOS) in 20 COPD and 10 control participants during resting respiration and metronome-paced breathing at 20, 30 and 40 tidal breaths/min. The same measurements were made for COPD patients after SABA inhalation. Dyspnoea was evaluated using the modified Medical Research Council (MRC) scale. RESULTS: In patients with COPD, higher respiratory rates increased expiratory and inspiratory resistance at 5 Hz (R5), the difference in respiratory resistance at 5 Hz and 20 Hz (R5-R20), resonant frequency and decreased expiratory reactance. The decreases in expiratory reactance from 20 to 40 tidal breaths/min were significantly correlated with MRC scores. SABA inhalation significantly reduced the effect of increased respiratory rate on the reactance measurements. CONCLUSIONS: Characteristic changes in IOS measurements, particularly expiratory reactance, induced by increased respiratory rates, were correlated with severity of dyspnoea in COPD patients during their daily lives. IOS and paced breathing may be useful for assessing breathlessness in COPD.

Amniotic fluid lamellar body count as a novel biochemical marker for timing elective caesarean delivery.

The aim of this study is to evaluate the performance of amniotic fluid lamellar body count (LBC) on the timing of elective caesarean delivery (CS) at ≥ 39 weeks. After allocating the study group (group I, transient tachypnoea of newborn (TTN), n = 14), an age-matched control group (group II, no TTN, n = 79) was selected for amniotic fluid LBC analysis. The median amniotic fluid LBC levels in group I were significantly lower than in the control group. Furthermore, the median values of mean lamellar body volume, median lamellar body distribution width and lamellar bodycrit in group I were also significantly lower than in group II. The best amniotic fluid LBC value to predict TTN was 40.15 × 10(3)/µl, with 82.3% sensitivity and 64.3% specificity. The favourable sensitivity and specificity values to predict the TTN for amniotic fluid LBC may suggest using it as an elective caesarean delivery-time scheduling marker.

Severe tachypnoea and dyspnoea due to physiological hyperventilation in pregnancy.

Physiological hyperventilation and dyspnoea in pregnancy are well-established phenomena and commonly lead to a chronic respiratory alkalosis with compensatory renal excretion of bicarbonate. However, the underlying mechanism of dyspnoea during normal pregnancy remains largely undefined. Increasing progesterone levels are a primary factor leading to increased respiratory drive to ensure the rising metabolic demands of the pregnancy are met. Dyspnoea symptoms typically begin in the first or second trimester, are mild, and do not interfere with activities of daily living. We report the case of a 35-year-old female with severe physiological hyperventilation of pregnancy presenting with profound dyspnoea, tachypnoea, and presyncope from 18 weeks of gestation until delivery. Subsequent investigations revealed no identifiable underlying pathology. There remain limited reports of such severe physiological hyperventilation of pregnancy. This case highlights interesting questions regarding the respiratory physiology of pregnancy and underlying mechanisms.

Persistent Tachypnoea in Early Infancy: A Clinical Perspective.

Tachypnoea in the newborn is common. It may arise from the many causes of the respiratory distress syndrome such as hyaline membrane disease, transient tachypnoea of the newborn, meconium aspiration etc. Congenital heart disease rarely presents with early tachypnoea on day one or two, in contrast to the early presentation of cyanosis, unless there is "pump" (ventricular) failure such as may occur in a cardiomyopathy/myocarditis, or as a result of severe obstruction to either ventricle. Space-occupying lesions within the chest, for example from a diaphragmatic hernia or a congenital cystic adenomatoid malformation, may present with early tachypnoea, as can a metabolic cause resulting in acidosis. The aim of this paper, however, is to focus on infants where the tachypnoea persists or develops beyond the newborn period, at times with minimal signs but occasionally with serious underlying pathology. They include causes that may have originated in the newborn but then persist; for example, arising from pulmonary hypoplasia or polycythemia. Many congenital cardiac abnormalities, particularly those causing left sided obstructive lesions, or those due to an increasing left to right shunt from large communications between the systemic and pulmonary circulations, need be considered. Respiratory causes, for example arising from aspiration, primary ciliary dyskinesia, cystic fibrosis, or interstitial lung disease, may lead to ongoing tachypnoea. Infective causes such as bronchiolitis or infantile wheeze generally are readily recognisable. Finally, there are a few infants who present with persistent tachypnoea over the first few weeks/months of their life who remain well and have normal investigations with the tachypnoea gradually resolving. How should one approach infants with persistent tachypnoea?

Assessing lung aeration using ultrasound after birth in near-term lambs at risk of respiratory distress.

Background: Optimizing respiratory support after birth requires real-time feedback on lung aeration. We hypothesized that lung ultrasound (LUS) can accurately monitor the extent and progression of lung aeration after birth and is closely associated with oxygenation. Methods: Near-term (140 days gestation, term ∼147 days), spontaneously breathing lambs with normal (controls; n = 10) or elevated lung liquid levels (EL; n= 9) were delivered by Caesarean section and monitored for four hours after birth. LUS (Phillips CX50, L3-12 transducer) images and arterial blood gases were taken every 5-20 min. LUS images were analyzed both qualitatively (grading) and quantitatively (using the coefficient of variation of pixel intensity (CoV) to estimate the degree of lung aeration), which was correlated with the oxygen exchange capacity of the lungs (Alveolar-arterial difference in oxygen; AaDO2). Results: Lung aeration, measured using LUS, and the AaDO2 improved over the first 4 h after birth. The increase in lung aeration measured using CoV of pixel intensity, but not LUS grade, was significantly reduced in EL lambs compared to controls (p = 0.02). The gradual decrease in AaDO2 after birth was significantly correlated with increased lung aeration in both control (grade, r2 = 0.60, p < 0.0001; CoV, r2 = 0.54, p < 0.0001) and EL lambs (grade, r2 = 0.51, p < 0.0001; CoV, r2 = 0.44, p < 0.0001). Conclusions: LUS can monitor lung aeration and liquid clearance after birth in spontaneously breathing near-term lambs. Image analysis techniques (CoV) may be able detect small to moderate differences in lung aeration in conditions with lung liquid retention which are not readily identified using qualitative LUS grading.

Clinical spectrum and outcome of patients visiting coronavirus screening centre in North India and clinical predictors for COVID-19.

AIM: The aim of this study is to elucidate the demographics, symptoms and outcome of sick persons visiting coronavirus (COVID) screening OPD of a tertiary institute in North India. STUDY DESIGN: The present descriptive, prospective study was done on 1030 patients and information about presenting symptoms, demographics (age, sex, nationality, residence), contact and travel history, comorbidities etc., were recorded. On the basis of criteria given by Indian Council of Medical Research, patients were divided into suspected (SARS-CoV-2) and non-suspected group. Of the suspected patients, with RT-PCR test positive were classified as confirmed COVID-19 case and negative RT-PCR symptomatic individual were defined as negative COVID-19 case. RESULTS: Out of the total patients, 65.6% were male and 34.4% were females. The mean age was 37.04 years. Fever 49.3%, cough 57.1% and sore throat 43.5% were the main symptoms. Comorbidities were seen in 8.5% patients with hypertension (3.5%) and diabetes mellitus (3.4%). Forty patients were positive. Highly significant correlation (P < 0.01) was found between COVID-19 positive status and in patients without any symptoms, between COVID-19 and cough and sore throat, between COVID-19 and comorbidity (diabetes mellitus), between COVID-19 and high-risk exposures (resident of hot spot and history of contact with confirmed case). Our study also found COVID-19 positive status, shortness of breath and tachycardia as independent predictors of mortality (P < 0.05). CONCLUSIONS: Most of the patients were young adults and males were mainly affected. Main presentation was cough followed by fever. Infectivity was higher in patients who had underlying comorbid diseases, especially diabetes and chronic kidney disease. Critical patients with decreased oxygen saturation, tachypnoea and tachycardia had strong predictability for COVID-19 positivity. COVID-19 positive status, shortness of breath and tachycardia are important predictors of mortality.

Pneumocystosis in a lurcher puppy.

A 10-month-old lurcher with history of recurrent skin problems, presented with tachypnoea which had progressively become severe. Investigations included haematology, serum biochemistry, blood coagulation profile, diagnostic imaging, bronchoscopy and bronchoalveolar lavage (BAL). Cytological evaluation of the BAL revealed the presence of Pneumocystis cysts. The patient was euthanased on humane grounds prior to treatment against Pneumocystosis. To the best of our knowledge this is the first case of Pneumocystosis in a lurcher puppy.

Contrasting characters of quick methods to measure respiratory rate in a clinical setting.

INTRODUCTION: Many medical professionals unofficially use quick methods for saving time. However, the evidence of such assessments is limited. The main aim of this article is verifying the agreement of these methods. OBJECTIVES: Overall, 106 out-patients were simultaneously evaluated with respect to the respiratory time measurement (RTM; 60 divided by the single respiratory time), 15 seconds period quadruple respiratory rate (15secRR; 15 seconds respiratory rate multiplied by 4), and 1-min respiratory rate (1minRR; gold standard respiratory rate). METHOD: We assessed the correlation, Bland-Altman plot, kappa value, and normalized root mean square error of the quick methods for the respiratory rate, with 1minRR as the gold standard. RESULTS: The mean ± SD of 1minRR, RTM, and 15secRR are 20.4 ± 5.6, 19.1 ± 5.7, and 21.4 ± 6.5 breathes per minute, respectively. The correlation between RTM and 1minRR was 0.85 (95% confidence interval [95% CI]: 0.79-0.90), while that between 15secRR and 1minRR was 0.81 (95% CI: 0.74-0.87). The kappa coefficients between RTM and 1minRR, between 15secRR and 1minRR, and between RTM and 15secRR were 0.57 (95% CI: 0.41-0.72), 0.59 (95% CI: 0.43-0.74), and 0.37 (95% CI: 0.20-0.53), respectively. The normalized root mean square error between RTM and 1minRR was 16.9% and that between 15secRR and 1minRR was 15.0%. The Bland Altman plot demonstrated that RTM and 15secRR showed contrasting characteristics. CONCLUSION: Compared to the gold standard, RTM tends to underestimate, while 15secRR tends to overestimate the respiratory rate. Therefore, health care professionals should be aware of this methodological tendency to assess vital signs properly.

An Evaluation of Agreement of Breathing Rates Measured by a Novel Device, Manual Counting, and Other Techniques Used in Clinical Practice: Protocol for the Observational VENTILATE Study.

BACKGROUND: Respiratory rate (RR) is the most sensitive physiological observation to predict clinical deterioration on hospital wards, and poor clinical monitoring has been highlighted as a primary contributor to avoidable mortality. Patients in intensive care have their RR monitored continuously, but this equipment is rarely available on general hospital wards. OBJECTIVE: The primary objective is to assess the accuracy of the RespiraSense device in comparison with other methods currently used in clinical practice. The secondary objective is to assess the accuracy of the RespiraSense device in participants in different positions and when reading aloud. METHODS: A single-center, prospective observational study will investigate the agreement of the RespiraSense device as compared with other device measurements (capnography, electrocardiogram) and the current standard measurement of RR (manual counting by a trained health care professional). The different methods will be employed concurrently on the same participant as part of a single study visit. RESULTS: Recruitment to this study has not yet started as funding decisions are still pending. Therefore, results are not available at this stage. It is anticipated that the data required could be collected within 2 months of first recruitment to the study and data analysis completed within 6 months of the study start date. CONCLUSIONS: The Evaluation of Agreement of Breathing Rates Measured by a Novel Device, Manual Counting, and Other Techniques Used in Clinical Practice (VENTILATE) study will provide further validation of the use of the RespiraSense device in subjects with abnormal respiratory rates. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/15437.

Association between uterine contractions before elective caesarean section and transient tachypnoea of the newborn: a retrospective cohort study.

OBJECTIVE: We evaluated the association between the presence of predelivery uterine contractions and transient tachypnoea of the newborn (TTN) in women undergoing an elective caesarean section. DESIGN: A retrospective cohort study. SETTING: National Hospital Organization Kofu National Hospital, which is a community hospital, between January 2011 and May 2019. PARTICIPANTS: The study included 464 women who underwent elective caesarean section. The exclusion criteria were missing data, twin pregnancy, neonatal asphyxia, general anaesthesia and elective caesarean section before term. PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were grouped according to the presence or absence of uterine contractions on a 40-min cardiotocogram (CTG) performed within 6 hours before caesarean delivery. We performed a multivariable logistic regression analysis to examine the association between predelivery uterine contractions and TTN. RESULTS: The incidence of TTN was 9.9% (46/464), and 38.4% (178/464) of patients had no uterine contraction. The absence of uterine contractions was significantly associated with an increased risk of TTN (adjusted OR 2.04; 95% CI 1.09 to 3.82) after controlling for gestational diabetes mellitus, small for gestational age, male sex and caesarean section at 37 weeks. CONCLUSIONS: Accurate risk stratification using a CTG could assist in the management of infants who are at risk of developing TTN.

Prolonged acidosis is a feature of SGLT2i-induced euglycaemic diabetic ketoacidosis.

SUMMARY: We describe two cases of SGLT2i-induced euglycaemic diabetic ketoacidosis, which took longer than we anticipated to treat despite initiation of our DKA protocol. Both patients had an unequivocal diagnosis of type 2 diabetes, had poor glycaemic control with a history of metformin intolerance and presented with relatively vague symptoms post-operatively. Neither patient had stopped their SGLT2i pre-operatively, but ought to have by current treatment guidelines. LEARNING POINTS: SGLT2i-induced EDKA is a more protracted and prolonged metabolic derangement and takes approximately twice as long to treat as hyperglycaemic ketoacidosis. Surgical patients ought to stop SGLT2i medications routinely pre-operatively and only resume them after they have made a full recovery from the operation. While the mechanistic basis for EDKA remains unclear, our observation of marked ketonuria in both patients suggests that impaired ketone excretion may not be the predominant metabolic lesion in every case. Measurement of insulin, C-Peptide, blood and urine ketones as well as glucagon and renal function at the time of initial presentation with EDKA may help to establish why this problem occurs in specific patients.

The Mozart study: a relation between dynamic hyperinflation and physical activity in patients with chronic obstructive pulmonary disease?

BACKGROUND: Many patients with chronic obstructive pulmonary disease (COPD) experience dyspnoea during exercise, resulting in a reduction of physical activity (PA). Dynamic hyperinflation (DH) is seen as a major cause of dyspnoea in COPD. OBJECTIVE: The objective of the current study was to investigate the relationship between DH, in terms of the amount of DH and the development and recovery rate of DH in patients with COPD, and PA. METHODS: Thirty-five patients with stable COPD were included from an outpatient clinic (14 GOLD II and 21 GOLD III, median age 65). PA was assessed using an accelerometer. Subjects underwent metronome-paced tachypnoea (MPT) to induce DH. To quantify the amount of DH during MPT, a decrease in inspiratory capacity (IC) or a change in IC as percentage of total lung capacity was used. RESULTS: No significant correlations were found between the parameters describing DH and PA. Secondary correlation analyses showed a negative correlation between static hyperinflation (SH) and PA (r = -0·39; P = 0·02). The pattern of breathing during MPT and the test itself showed high interpatient variability. CONCLUSIONS: The absence of a significant correlation between DH and PA is contrary to previous studies. SH did show a correlation with PA. The variety in results and the technical difficulties in execution of the measurements ask for a new, more reliable, method to detect DH and investigate its relation with PA in patients with COPD.

There is Only a Modest Increase in Neonatal Respiratory Morbidity Following Early Term Elective Cesarean in a South Indian Population.

OBJECTIVES: Elective cesarean deliveries (ECD) are still performed prior to 39 weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39 weeks, in this local population. METHODS: We analyzed NRM among 1329 deliveries (584 ECD and 745 spontaneous vaginal delivery, SVD) in a tertiary hospital over 2 years. Neonates were grouped into: A: 35+0-36+6 weeks, B: 37+0-38+6 weeks, and C: ≥39 weeks. NRM was compared between ECD versus SVD. RESULTS: Majority (433/584) of ECDs were performed between 37+0 and 38+6 weeks. Overall, 32% received steroid prophylaxis. Of 1329 newborns, 18/584 (3.82%) in ECD and 6/745 (0.8%) in SVD group developed NRM (p value of 0.004, OR 3.9, CI 1.54-9.93). Need of respiratory support among ECD was 4.28% compared to 0.53% in SVD (p < 0.001, OR 8.28; CI 2.86-23.94). However, comparing neonates born by ECD between groups B Vs C; there was only a modest increase in NRM (2.07 vs 0.9%; p 0.48, OR 2.3 with CI 0.29-18.4) and in need of respiratory support (2.54 vs 0.9%; p 0.47, OR 2.84; CI 0.36-22.2). CONCLUSION: NRM following early term ECD continues to be a healthcare burden in India. Interestingly in this South Indian population, early term ECDs caused only modest increase in NRM, and this ethnic variation requires further evaluation to determine ideal time for ECD in local population.