A pilot trial of non-invasive home ventilation after acidotic respiratory failure in chronic obstructive pulmonary disease.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) who survive an episode of acute hypercapnic respiratory failure (AHRF) after treatment with non-invasive ventilation (NIV) have a high risk of recurrent AHRF. We hypothesised that continuation of NIV at home in these patients would reduce the likelihood of recurrent AHRF. METHODS: A pilot prospective randomised controlled study was designed to compare continuation of active home NIV and continuous positive airway pressure (CPAP) 5 cm H(2)O (controls) in COPD patients who had survived an episode of AHRF treated with acute NIV. Patients with significant obstructive sleep apnoea, non-COPD causes of AHRF, adverse psychosocial circumstances and serious comorbidities were excluded. The primary end-point was recurrent AHRF requiring acute NIV, intubation or resulting in death in the first year. RESULTS: Twenty-three patients were randomised to receive home NIV and 24 received CPAP. There was no significant difference in the baseline characteristics between the two study groups. The proportion of patients developing recurrent AHRF in the NIV and the CPAP groups was 38.5% vs. 60.2% at 1 year (P = 0.039). Four and eight patients, respectively, were withdrawn from the CPAP and NIV groups before the end of the pre-defined study duration. CONCLUSIONS: In selected COPD patients with AHRF treated with acute NIV, continuation with home NIV is associated with a lower risk of recurrent severe COPD exacerbation with AHRF when compared with CPAP.

Major haemoptysis in Hong Kong: aetiologies, angiographic findings and outcomes of bronchial artery embolisation.

SETTING: Tertiary referral centres. OBJECTIVE: To provide comprehensive updates on the aetiologies, angiographic findings and outcomes of bronchial artery embolisation (BAE) for life-threatening haemoptysis in Hong Kong. DESIGN: Retrospective review of clinical records of consecutive patients presenting with life-threatening haemoptysis from 2000 to 2006. RESULTS: There were 3006 admissions due to haemoptysis involving 2260 patients during the study period; of these, 251 patients had life-threatening haemoptysis. Pulmonary tuberculosis (PTB) (active or inactive) and bronchiectasis were the main underlying causes. BAE was attempted in 167 patients. There was a high prevalence of bilateral bronchial arterial abnormalities (31.7%), presence of abnormal non-bronchial arteries (41.3%) and presence of broncho-pulmonary shunt (38.9%). BAE had a high immediate success rate of 95.7%, with a 5-year recurrence rate of 45.0%. Recurrent life-threatening haemoptysis was independently associated with past history of haemoptysis (P = 0.024), presence of broncho-pulmonary shunt (P = 0.013), and incomplete embolisation (P = 0.002). Complications were uncommon (<5%) and self-limiting. CONCLUSIONS: In Hong Kong, about one tenth of admissions due to haemoptysis were life-threatening. PTB and bronchiectasis were the major causes. Complications due to BAE were uncommon and self-limiting, with super-selective catheters.

Duration of RT-PCR positivity in severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a highly infectious respiratory infection with a high mortality. The duration of infectivity is unknown. The RT-PCR positivity for SARS-associated coronavirus (SARS-CoV) was followed in 45 virologically confirmed SARS patients. Serial RT-PCRs for SARS-CoV were performed in the nasopharyngeal aspirate, stool and urine of 45 SARS patients who survived until discharge. All patients had at least one site that was positive for SARS-CoV on presentation. Time to RT-PCR conversion was studied in all patients. There were 15 males (33.3%) and 30 females (66.7%), with a mean+/- SD age of 40.7+/-14.7 yrs. The median (range) time of RT-PCR conversion was 30 days (2-81). On discharge from the hospital, 18 (40%) remained RT-PCR positive in at least one site. For patients with positive RT-PCR on discharge, the median (range) time to RT-PCR conversion after discharge was 13 days (2-60). A significant proportion of severe acute respiratory syndrome patients remained RT-PCR positive for severe acute respiratory syndrome-associated coronavirus for a substantial duration after discharge. The clinical significance is unknown and this finding merits further study. It is prudent to advise patients to adhere to strict personal hygiene on discharge until RT-PCR becomes negative.