The use of extracorporeal membrane oxygenation in the treatment of critical course of pneumonia.

Extracorporeal membrane oxygenation is the highest form of resuscitation care in management of patients with respiratory failure. In the case of acute respiratory distress syndrome, the veno-venous setting is more often used. ECMO support enables, in case of lung function failure, to obtain the necessary time for the onset of the causal treatment effect or is used as a bridge to transplantation Mortality of the patients varies according to the underlying cause and presence of risk factors (e.g., age, complications or comorbid diseases). The onset of the COVID-19 pandemic has led to a significant increase in the need for ECMO. The quality of life of patients after ECMO is significantly reduced, but most patients do not experience permanent disability.

[Respiratory manifestations of post-COVID syndrome].

Overcoming infection with coronavirus disease 2019 (COVID-19) can lead to the persistence of various symptoms in some patients. The complex of symptoms causally related to severe acute respiratory coronavirus 2 infection is called post-COVID syndrome. One of the most common respiratory complications is pulmonary fibrosis, especially after critical course of the disease. In some patients, however, only the peripheral airways are affected by the air-trapping seen on high-resolution computed tomography scans. Less common respiratory complications include sarcoidosis and pneumatoceles. This narrative review summarizes current knowledge about pulmonary involvement as part of post-COVID syndrome.

Chronic lung diseases and sleep.

Sleep is vitally important part of our life. Its quality and quantity influence all physiological processes in our organism. The relationship between the lung diseases and sleep is bidirectional - the lack of quality sleep worsens the compensation and the course of the diseases and in the same time chronic lung diseases are negatively affecting sleep quality. The coexistence of the sleep disordered breathing and lung disorders is another important issue to discuss. In case of chronic obstructive pulmonary disease the overlap with sleep disordered breathing is characterized by higher prevalence of hypercapnia and overall worse prognosis. Moreover, there is a growing body of evidence about possible links of sleep disordered breathing to lung fibrosis and tumors. The complex healthcare in patients with respiratory diseases should not omit sleep examination.

COVID-19 and post-COVID - Jekyll and Hyde of modern medicine.

COVID-19 pandemic has massive impact on the whole world, lead to the death of milions of people and required excessive restrictions with large economical, psychological and other impacts. Post-COVID syndrome is defined according to the Czech pneumological and phtizeological society as a complex of symptoms persisting for more than 12 weeks from the acute stage of COVID-19 and which is not possible to explain by other causes. Exact pathopysiological mechanisms and its frequency are still not known, and the data from the literature are not consisent. We present case reports of 2 patients with very different disease and convalescence course. COVID-19 and post-COVID syndrome represent large space for the further research. The prediction of the persisting limitations and other consequencies of the diseases is still not possible. Even though there is usualy higher incidence of post-COVID symptoms in patients surviving severe COVID-19 course, the presented case reports show paradoxically exactly the oposite situation.

Inhaled glucocorticoids in treatment of covid-19.

Covid-19 pandemic affects heavily different health care systems. The most important factor/aspect is high number of hospitalized patients in countries with low level of infrastructure. Because of this, many therapeutic methods reducing the risk of more severe course of disease are now under development. The key part of this review is the STOIC trial, which is the largest, randomized trial assessing the effect of inhaled glucocorticoid treatment on the risk of hospitalization due to covid-19.

Bilateral multiple pneumatocele as a rare late complication of COVID-19 pneumonia.

Pneumatocele is a cavity, which may develop rarely as a complication of pneumonia. It is more common in patients requiring ventilation support. After COVID-19 pneumonia, there are only several case reports described. Our case report is about a male patient without any serious commorbities. The patient had bilateral multiple pneumatocele which have formed in postacute phase of moderate course of COVID-19. Other possible causes have been exluded by a complex examination. During the follow-up there was a clear gradual spontaneous resorption of the finding. The patient is still in very good clinical condition.

Is population's cardiorespiratory fitness really declining?

OBJECTIVE: Cardiorespiratory fitness (CRF) is defined as the capacity of the cardiovascular and pulmonary systems to meet the oxygen demands of the body during physical work. Poor CRF is connected with a higher risk for the development of various noninfectious diseases such as cardiovascular disease or malignancies. The standard test for the assessment of CRF is exercise testing with the measurement of maximal oxygen consumption (VO2 max). Standard VO2 max values for adult men and women in the Czech Republic have been available since the 1970s without being updated. According to experts, these standard values are now unusable for contemporary CRF measurements of the population in the Czech Republic. The Fitness Registry and the Importance of Exercise: a National Database (FRIEND) - 4,494 patients (1,717 men) defined new standard values for bicycle ergometry CRF for the population in the United States of America. The aim of the study was the statistical comparison of VO2 max values (reference standards) in the 1970s population in the Czech Republic with the new reference standards of the FRIEND registry. METHODS: All analyses were performed using IBM SPSS statistics and all tests with a p-value of less than 0.05 were considered statistically significant. RESULTS: VO2 max norms for women in the Czech population were higher in all age categories with statistically significant differences in the categories 30-39, 40-49 and 50-59 (p < 0.001). In the male population aged 20-29 years, VO2 max was significantly higher in the FRIEND registry (p < 0.001) in contrast to the other age categories, 30-39, 40-49 and 50-59, which were significantly higher in the Czech population (p < 0.001). CONCLUSIONS: Czech VO2 max population norms from the 1970s are (with the exception of age category 20-29 years) higher than values from the recent FRIEND registry.

Drug induced lung toxicity by nitrofurantoin

We present the clinical case of the patient with nitrofurantoin (FUR) lung toxicity. Diagnosis was made from detailed history of the patient and by studying CT images before the start of FUR treatment. An extensive interstitial changes were evident on HRCT scan at the presentation at our clinic. The definitive diagnosis was supported by negative microbiology and autoantibody screening and almost complete regression of changes after FUR treatment withdrawal. There was no need for corticosteroid treatment or immunosuppressive medication.

Advance in sleep medicine and non-invasive ventilation in respiratory medicine.

Non-invasive ventilation represents one of the milestones in respiratory and sleep medicine. In this article is presented brief history of non-invasive ventilation and overview of different regimes of non-invasive ventilation used in the treatment of patients with obstructive sleep apnoea and chronic obstructive pulmonary disease.

Limited ambulatory night sleep testing in patients with a suspicion of sleep apnoea syndrome: Is its indication tenable?

INTRODUCTION: Ambulatory sleep testing is nowadays an available diagnostic method, measuring air flow and blood oxygen saturation in patients with a suspicion of obstructive sleep apnoea syndrome (OSAS). It can be performed by either a general practitioner or an ambulatory specialist in various fields. Using this simple screening method it is possible to exclude subjects without OSAS, who therefore do not require further sleep testing at a sleep laboratory. There is no published data regarding the use of ambulatory sleep testing by sleep laboratories in the Czech Republic. The aim of this study was to evaluate the proportion of patients examined by ambulatory sleep testing and to determine the factors influencing its indication. MATERIAL AND METHODS: The study involved 497 patients (363 males) with an average age of 55.5 ± 12.3 years. These patients were tested by the sleep laboratory at University Hospital Olomouc with a suspicion of OSAS. The clinical complaints of the patients were evaluated (e.g. excessive daytime sleepiness, microsleeps, etc.) along with a basic examination, including anthropometric parameter measurements, on admission to the ward. Whilst admitted, night sleep testing using respiratory polygraphy or videopolysomnography was performed in all patients. Furthermore, the number of patients that underwent ambulatory sleep testing prior to admission to the sleep laboratory and the number of patients with an indication for positive airway pressure therapy (PAP) (apnoea-hypopnea index > 15) was assessed. The results were processed using the software IBM SPSS Statistics v22. RESULTS: Ambulatory sleep testing was performed in only 96 patients (19.3 %). Among these patients, 76 (79.0 %) were diagnosed with OSAS with an indication for PAP. In the 401 patients who did not undergo ambulatory sleep tests, 227 (53.9 %) were diagnosed with OSAS with an indication for PAP. Patients who underwent ambulatory sleep tests and those who did not differed only in age (p = 0.03). There were no significant differences in other parameters (sex, height, weight, BMI, circumference of neck, waist and hips, ESS), including sleepiness (p = 0.605) and microsleeps (p = 0.74). CONCLUSION: Ambulatory sleep testing is performed in only a small proportion of patients. Its use can reduce healthcare costs as well as waiting times for sleep laboratory tests.

[Epicardial fat and osteoprotegerin - does a mutual relation exist? Pilot study]. / Epikardiální tuk a osteoprotegerin - existují vzájemné souvislosti? Pilotní studie.

INTRODUCTION: Epicardial fat (EPI) plays important role in development of metabolic and cardiovascular diseases. According to population studies EPI represents independent risk factor of cardiovascular diseases (CVD) and also for neoplasms. Osteoprotegerin (OPG) is a glycoprotein which have role in regulation of immune and cardiovascular systems. High serum levels of OPG are connected with high cardiovascular risk. The aim of our study was to evaluate possible correlation between EPI and OPG level in asymptomatic relatives of patients with CVD. MATERIAL AND METHODS: 53 asymptomatic relatives (37 male) (median age 53 years) of patients with CVD (ischemic heart disease, cerebrovascular disease) were included. Physical examination and biochemistry analysis were performed. GE Vivid 7 (GE Medical) was used for echocardiography. EPI was measured according to guidelines using parasternal long axis in diastole as a space in front of right ventricle. RESULTS: EPI was present in 46 subjects (86.8 %) with mean value of 2.91 mm. In 10 subjects was the amount of EPI > 5 mm. Spearmann correlation analysis found statistically significant correlation between EPI and OPG (r = 0.271; p = 0.05) and age (r = 0.500; p < 0.0001). We have not found correlation between EPI, glycaemia and level of insulin, glycated Hb, total, LDL, HDL cholesterol and triglycerides. CONCLUSION: We have found positive correlation between EPI and OPG. More studies are needed to confirm applicability of this correlation in risk stratification.Key words: cardiovascular risk - epicardial fat - osteoprotegerin.

[Beta-blockers and chronic obstructive pulmonary disease]. / Betablokátory a chronická obstrukcní plicní nemoc.

This general article discusses the problems of beta-blockers use in patients with chronic obstructive pulmonary disease (COPD). Its aim is to refute exaggerated concerns of physicians over possible undesirable effects of beta-blockers on the patient respiratory functions and present new data on the effects of beta-blockers on the extent of COPD exacerbations, bronchial reactivity and mortality of patients.

[Research of relations among sleep disorders, obstructive sleep apnoea, hypertension onset and hypertensive treatment - current or long-term trend?]. / Studium souvislostí poruch spánku, obstrukcní spánkové apnoe a vzniku a lécby arteriální hypertenze - módní vlna nebo dlouhodobý trend?

This paper is discussing recent findings about links between obstructive sleep apnea syndrome and arterial hypertension. It describes diagnostic approaches and also therapy of patients. It is describing options of pharmacological treatment and the influence of continuous positive airway pressure therapy on blood pressure level.

The effectiveness of glucocorticoid treatment in post-COVID-19 pulmonary involvement.

RATIONALE: Persistent respiratory symptoms following Coronavirus Disease 2019 (COVID-19) are associated with residual radiological changes in lung parenchyma, with a risk of development into lung fibrosis, and with impaired pulmonary function. Previous studies hinted at the possible efficacy of corticosteroids (CS) in facilitating the resolution of post-COVID residual changes in the lungs, but the available data is limited. AIM: To evaluate the effects of CS treatment in post-COVID respiratory syndrome patients. PATIENTS AND METHODS: Post-COVID patients were recruited into a prospective single-center observational study and scheduled for an initial (V1) and follow-up visit (V2) at the Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc, comprising of pulmonary function testing, chest x-ray, and complex clinical examination. The decision to administer CS or maintain watchful waiting (WW) was in line with Czech national guidelines. RESULTS: The study involved 2729 COVID-19 survivors (45.7% male; mean age: 54.6). From 2026 patients with complete V1 data, 131 patients were indicated for CS therapy. These patients showed significantly worse radiological and functional impairment at V1. Mean initial dose was 27.6 mg (SD ± 10,64), and the mean duration of CS therapy was 13.3 weeks (SD ± 10,06). Following therapy, significantly better improvement of static lung volumes and transfer factor for carbon monoxide (DLCO), and significantly better rates of good or complete radiological and subjective improvement were observed in the CS group compared to controls with available follow-up data (n = 894). CONCLUSION: Better improvement of pulmonary function, radiological findings and subjective symptoms were observed in patients CS compared to watchful waiting. Our findings suggest that glucocorticoid therapy could benefit selected patients with persistent dyspnea, significant radiological changes, and decreased DLCO.

Clinical presentation and pulmonary function tests in post-acute COVID-19 patients.

AIMS: The study analysed post-acute COVID-19 symptoms and the pulmonary function test (PFT) results in patients surviving the native strain of the virus. METHODS: The study was prospective; the inclusion criteria were positive PCR test for SARS-CoV-2 and age 18-100. Exclusion criteria were active respiratory infection, known or suspicious pre-existing pulmonary disease, cardiac failure, recent or acute pulmonary embolism, anaemia, and neuromuscular diseases. The recruitment period was 1st March 2020 - 25th December 2020. The initial examination was performed 4-12 weeks after the disease onset. All subjects underwent physical examination, anamnesis, chest x-ray and PFT. RESULTS: The study involved 785 subjects (345 male) mean age 53.8 (SD 14.6). The disease severity groups were: mild (G1), moderate (G2) and severe/critical (G3). Anosmia was present in the acute disease phase in 45.2% of G1 patients, but only in 4.5% of G3 patients. Dyspnoea occurred frequently in more severe groups (40%, 51.8% and 63.7% for G1, G2 and G3 respectively), while cough and fatigue showed no relationship to disease severity. Females were more likely to experience persistent symptoms. PFT results were significantly decreased in more severe groups compared to the mild COVID-19 patients, diffusing capacity was 86.3%, 79% and 68% of predicted values in G1, G2 and G3 respectively. CONCLUSION: Anosmia during the acute phase was associated with mild disease, persisting dyspnoea was more frequent after more severe COVID-19. Females tended to have persisting symptoms in post-acute phase more frequently. PFT results showed decrease with disease severity.

Pupillography in contemporary sleep medicine - A narrative review.

Excessive daytime sleepiness (EDS) is a common symptom of sleep disorders such as narcolepsy, obstructive sleep apnea, and hypersomnia. The most common tools for assessing EDS are various specialized questionnaires such as Epworth Sleepiness Scale (ESS) and Stanford Sleepiness Scale (SSS). However, the scores obtained from self-rating questionnaires do not seem to measure physiological sleepiness but rather a more complex phenomenon of subjective sleepiness modulated by other factors such as motivation, expectation, and capability of self-perception. The golden standard for measuring physiological sleepiness and assessing EDS is the Multiple Sleep Latency Test (MSLT). However, MSLT is very time consuming and requires trained personnel and expensive equipment. Different method modifications are employed in various medical and industrial fields for different purposes. The infrared pupillography in darkness has the potential to measure objective physiological sleepiness, especially the Pupillographic Sleepiness Test (PST), which is the method of choice for pupillographic measurement of daytime sleepiness. The method has also been employed in several specific sleep disorders, outlining possible future usage. This narrative review summarizes the current state of knowledge on the relevance and usefulness of pupillography in sleep medicine.

Post-COVID Syndrome and Cardiorespiratory Fitness-26-Month Experience of Single Center.

INTRODUCTION: Persistent post-COVID syndrome, also referred to as long COVID, is a pathologic entity that involves persistent physical, medical, and cognitive sequelae following COVID-19. Decreased fitness has repeatedly been reported in numerous studies dealing with post-COVID syndrome, however, it is still not fully clear which groups of patients may be more susceptible for persisting symptoms. AIM: The aim of our study was to evaluate the number of post-COVID patients with cardiac symptoms, where these patients were evaluated by CPET and the results compared with a control group of patients. METHODS: Follow-up of patients in post-COVID outpatient clinic from 1 March 2020 to 31 May 2022. Inclusion criteria were positive PCR test for SARS-CoV-2 and age 18-100. The initial examination was performed 4-12 weeks after the disease onset. All patients with possible cardiac symptoms had completed cardiopulmonary exercise testing. The control group was randomly selected from a database of clients in 2019, with the preventive reason for evaluation. RESULTS: From 1 March 2020 to 31 May 2022, 2732 patients (45.7% males) were evaluated with a mean age of 54.6 ± 14.7. CPET was indicated only in 97 patients (3.5%). Seventy-four patients (26 male) achieved the exercise maximum and a comparison were made with a control group (same age (p = 0.801), BMI (p = 0.721), and sex ratio). No significant dependence between the parameter VO2 max mL/kg/min and post-COVID disability was demonstrated (p = 0.412). Spearman's correlation analysis did not show a significant relationship between the parameter VO2 max mL/kg/min and the severity of COVID-19 (p = 0.285). CONCLUSIONS: Cardiac symptoms occurred in only a small percentage of patients in our study. There is a need for further studies that would objectively evaluate the effect of COVID-19 disease on the patient's health.

Cognitive Functions, Depressive and Anxiety Symptoms After One Year of CPAP Treatment in Obstructive Sleep Apnea.

Objective: The study worked with depressive symptoms, anxiety score and cognitive functions in obstructive sleep apnea (OSA) patients treated with CPAP. Methods: Eighty-one subjects with OSA and without psychiatric comorbidity were treated with CPAP for one year and completed the following scales and cognitive tests: Trail Making Test, Verbal Fluency Test, d2 Test, Beck Depression Inventory-II and Beck Anxiety Inventory. MINI ruled out psychiatric disorder. At the two months check-up, subjects were re-evaluated for depressive and anxiety symptoms, and after one year of CPAP treatment, subjects repeated cognitive tests and scales. Data about therapy adherence and effectiveness were obtained from the patient's CPAP machines. Results: The study was completed by 59 CPAP adherent patients and eight non-adherent patients. CPAP therapy effectiveness was verified in all patients by decreasing the apnea-hypopnoea index below 5 and/or 10% of baseline values. The adherent patients significantly improved depressive and anxiety symptoms. There was also an improvement in overall performance in the attention test; however, performance in many individual items did not change. The adherent patients also improved verbal fluency and in the Part B of the Trail making test. The non-adherent group significantly increased the number of mistakes made in the d2 test; other results were non-significant. Conclusion: According to our results, OSA patients' mood, anxiety and certain cognitive domains improved during the one-year therapy with CPAP. Trial Registration Number: NCT03866161.

Artificial-Intelligence-Driven Algorithms for Predicting Response to Corticosteroid Treatment in Patients with Post-Acute COVID-19.

Pulmonary fibrosis is one of the most severe long-term consequences of COVID-19. Corticosteroid treatment increases the chances of recovery; unfortunately, it can also have side effects. Therefore, we aimed to develop prediction models for a personalized selection of patients benefiting from corticotherapy. The experiment utilized various algorithms, including Logistic Regression, k-NN, Decision Tree, XGBoost, Random Forest, SVM, MLP, AdaBoost, and LGBM. In addition easily human-interpretable model is presented. All algorithms were trained on a dataset consisting of a total of 281 patients. Every patient conducted an examination at the start and three months after the post-COVID treatment. The examination comprised a physical examination, blood tests, functional lung tests, and an assessment of health state based on X-ray and HRCT. The Decision tree algorithm achieved balanced accuracy (BA) of 73.52%, ROC-AUC of 74.69%, and 71.70% F1 score. Other algorithms achieving high accuracy included Random Forest (BA 70.00%, ROC-AUC 70.62%, 67.92% F1 score) and AdaBoost (BA 70.37%, ROC-AUC 63.58%, 70.18% F1 score). The experiments prove that information obtained during the initiation of the post-COVID-19 treatment can be used to predict whether the patient will benefit from corticotherapy. The presented predictive models can be used by clinicians to make personalized treatment decisions.

Long-Term Follow-Up of Patients Needing Extracorporeal Membrane Oxygenation Following a Critical Course of COVID-19.

INTRODUCTION: Severe respiratory failure is one of the most serious complications of coronavirus disease 2019 (COVID-19). In a small proportion of patients, mechanical ventilation fails to provide adequate oxygenation and extracorporeal membrane oxygenation (ECMO) is needed. The surviving individuals need long-term follow-up as it is not clear what their prognosis is. AIM: To provide a complex clinical picture of patients during follow-up exceeding one year after the ECMO therapy due to severe COVID-19. METHODS: All subjects involved in the study required ECMO in the acute stage of COVID-19. The survivors were followed-up for over one year at a specialized respiratory medical center. RESULTS: Of the 41 patients indicated for ECMO, 17 patients (64.7% males) survived. The average age of survivors was 47.8 years, and the average BMI was 34.7 kg·m-2. The duration of ECMO support was 9.4 days. A mild decrease in vital capacity (VC) and transfer factor (DLCO) was observed on the initial follow-up visit (82.1% and 60%, respectively). VC improved by 6.2% and by an additional 7.5% after 6 months and 1 year, respectively. DLCO improved by 21.1% after 6 months and remained stable after 1 year. Post-intensive care consequences included psychological problems and neurological impairment in 29% of patients; 64.7% of the survivors got vaccinated against SARS-CoV-2 within 12 months of hospitalization and 17.6% experienced reinfection with a mild course. CONCLUSION: The COVID-19 pandemic has significantly increased the need for ECMO. Patients' quality of life after ECMO is temporarily significantly reduced but most patients do not experience permanent disability.