Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study.

BACKGROUND: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. OBJECTIVE: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. METHODS: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. RESULTS: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. CONCLUSIONS: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design.

Effect of high flow nasal cannula on peripheral muscle oxygenation and hemodynamic during paddling exercise in patients with chronic obstructive pulmonary disease: a randomized controlled trial.

BACKGROUND: Exercise training for patients with chronic obstructive pulmonary disease (COPD) improves their endurance and oxygenation. Supplemental oxygen delivered by high flow nasal cannula (HFNC) reportedly improves the clinical outcomes during high-intensity exercise. However, the physical benefits of the provision of supplemental oxygen with HFNC for the improvement of exercise performance have not been fully investigated. This randomized trial aimed to evaluate the effect of HFNC on the hemodynamic status and peripheral muscle microcirculation during exercise training. METHODS: In this multicenter, randomized controlled parallel two-group study, 32 patients with moderate to severe COPD were randomly assigned into the nasal cannula (NC) group (n=15) with a flow rate of 2-3 L/min or the HFNC group (n=17) with a flow rate of 45 L/min for twelve 40 min exercise training sessions. RESULTS: The mean cardiac index (CI) and stroke volume (SV) of the NC group in the first session were significantly lower than those of the HFNC group (3.68±0.76 vs. 4.5±0.76 L/min/m2, P=0.014; 63.03±9.87 vs. 74.22±19.48, P=0.002, respectively). The systemic vascular resistance (SVR) of the NC group was significantly lower in the seventh session than in the first session (891±287 vs. 1,138±381 dyn-s/cm5, respectively, P=0.048). The mean deoxyhemoglobin level was higher in the HFNC group in the 1st session and lower in the 12th session (1.09±9.04 vs. 7.3±7.3 µm, P=0.046). The COPD Assessment Test score, Modified Medical Research Council scale score, maximum inspiratory pressure (MIP), and maximum expiratory pressure were different within and between the groups. CONCLUSIONS: HFNC, with a lower oxygen concentration than that used with a traditional NC, yielded lower deoxygenated hemoglobin levels after 12 suboptimal exercise training sessions. In contrast, the higher oxygen concentration delivered by NC reduced SVR. The COPD assessment score improved on exercise training, regardless of the supplemental oxygen delivery method.

Comparisons of Metabolic Load between Adaptive Support Ventilation and Pressure Support Ventilation in Mechanically Ventilated ICU Patients.

Purpose: The aim of this study was to compare the metabolic load between adaptive support ventilation (ASV) and pressure support ventilation (PSV) modes in critically ill patients. Methods: Sequential 20 min ventilation by PSV followed by 20 min ASV in critically ill patients was assessed. ASV was set for full support, i.e., with the minute volume control set at the same level as the minute volume observed during PSV. The trial started from PSV 8 cmH2O and continued with high (PSV 12 cmH2O) to low (PSV 0) conditions or low to high conditions, in random order. The oxygen consumption (VO2), production of carbon dioxide (VCO2), and energy expenditure (EE) were measured by indirect calorimetry (IC). Results: Twenty-four patients with critical illness participated in the study. Comparing with the PSV mode, the EE in the ASV mode was lower in the level of PSV 0 cmH2O (1069 ± 73 vs. 1425 ± 76 kcal), PS 8 cmH2O (1116 ± 70 vs. 1284 ± 61 kcal), and PS 12 cmH2O (1017 ± 70 vs. 1169 ± 58 kcal) (p < 0.05). The VO2, VCO2, and P0.1 in PSV were significantly higher than those in ASV (p < 0.05). The VO2, VCO2, and P0.1 in PSV were significantly higher than those in ASV (. Conclusion: In patients with critical illness, the application of ASV set for full support was associated with a lower metabolic load and respiratory drive than in any of the studied PSV conditions.

The Risk of Latent Tuberculosis Infection in Respiratory Therapists in a Country with Intermediate Incidence.

BACKGROUND: Respiratory therapists (RTs) are exposed to aerosols more frequently than other health care workers (HCWs) and might bear a higher risk for tuberculosis (TB) infection. The QuantiFERON-TB Gold (QFTG) test was used to evaluate the risk for TB infection in Taiwan, a country with intermediate TB incidence. METHODS: A cross-sectional screening of HCWs, including RTs and other HCWs, with the QFTG test was conducted in Taiwan between October 2008 and December 2011. Those with initially negative QFTG results accepted repeated QFTG testing 1 y later. The positive rates of QFTG in RTs and other HCWs were compared. The risk factors for positive QFTG and QFTG conversion, including occupational group, age, duration of employment, and gender, were analyzed. RESULTS: A total of 274 HCWs were enrolled, including 43 RTs, 163 nurses, and 68 other HCWs. The positive rates of QFTG were 14.0% in RTs, 6.1% in nurses, and 8.8% in other HCWs, which were not significantly different among the 3 groups. Multivariate analysis demonstrated that the risk for positive QFTG positively correlated with increased age and the duration of employment, but did not relate to gender or occupational group. Of 81 HCWs with initially negative QFTG results, 4 (4.9%) had positive conversion on repeat QFTG testing 1 y later. The risk for QFTG conversion in HCWs was not related to occupational group, gender, age, or duration of employment. CONCLUSION: RTs had no higher risk for latent TB infection than other HCWs in a country with intermediate TB incidence.

Recovery of pulmonary functions, exercise capacity, and quality of life after pulmonary rehabilitation in survivors of ARDS due to severe influenza A (H1N1) pneumonitis.

BACKGROUND: Acute respiratory distress syndrome (ARDS) due to severe influenza A H1N1 pneumonitis would result in impaired pulmonary functions and health-related quality of life (HRQoL) after hospital discharge. OBJECTIVES: The recovery of pulmonary functions, exercise capacity, and HRQoL in the survivors of ARDS due to 2009 pandemic influenza A H1N1 pneumonitis (H1N1-ARDS) was evaluated in a tertiary teaching hospital in northern Taiwan between May 2010 and June 2011. PATIENTS AND METHODS: Data of spirometry, total lung capacity (TLC), diffusing capacity of carbon monoxide (DLCO ), and 6-minute walk distance (6MWD) in the patients survived from H1N1-ARDS were collected 1, 3, and 6 months post-hospital discharge. HRQoL was evaluated with St. George respiratory questionnaire (SGRQ). RESULTS: Nine survivors of H1N1-ARDS in the study period were included. All these patients received 2 months' pulmonary rehabilitation program. Pulmonary functions and exercise capacity included TLC, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1 ), DLCO , and 6MWD improved from 1 to 3 months post-hospital discharge. Only TLC had further significant improvement from 3 to 6 months. HRQoL represented as the total score of SGRQ had no significant improvement in the first 3 months but improved significantly from 3 to 6 months post-discharge. CONCLUSION: The impaired pulmonary functions and exercise capacity in the survivors of H1N1-ARDS improved soon at 3 months after hospital discharge. Their quality of life had keeping improved at 6 months even though there was no further improvement of their pulmonary functions and exercise capacity.

High-frequency oscillatory ventilation for rescue from refractory hypoxemia in a patient with transfusion-related acute lung injury.

Transfusion-related acute lung injury is a serious complication of blood transfusions. Herein is a report on a 32-year-old woman who developed diffuse pulmonary infiltrates and acute respiratory compromise after blood transfusion. Non-cardiogenic pulmonary edema was diagnosed based on data calculated by the hemodynamic monitoring system, but severe hypoxemia persisted despite conventional pressure-control ventilation with 100% oxygen, low tidal volume, and high PEEP. The refractory hypoxemia was improved by high-frequency oscillatory ventilation. This experience suggests that high-frequency oscillatory ventilation may be beneficial for patients with transfusion-related acute lung injury and severe refractory hypoxemia.

Self-management behaviours for patients with chronic obstructive pulmonary disease: a qualitative study.

AIM: This paper is a report of a study to explore the self-management behaviours of patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: Chronic obstructive pulmonary disease is a major cause of chronic morbidity and mortality throughout the world. A patient-centred perspective calls for the investigation of self-management behaviours as means to develop self-management programmes and enhance quality of life for patients with COPD. METHOD: The participants were a convenience sample of 18 patients with COPD of various severities. Interview data were collected in the thoracic ward, outpatient department and pulmonary rehabilitation unit of a medical centre in Taiwan from November 2006 to April 2007. FINDINGS: Participants demonstrated the ability to choose suitable disease management behaviours to prevent symptoms and complications. Five themes of disease management behaviours were identified: symptom management, activity and exercise implementation, environmental control, emotional adaptation and maintaining a healthy lifestyle. CONCLUSION: Participants are experts on their lives and, as such, they adopt appropriate disease control behaviours, based on their experience and knowledge, as well as integrate the illness and its symptoms into their lives. With the worldwide increase in migration, an understanding of the cultural factors that influence patients' perspectives on self-management behaviours is necessary and can contribute to the development of an evidence-based programme for disease self-management with COPD.