Background In Taiwan, prolonged mechanical ventilation (PMV) has long imposed a substantial burden on healthcare systems, characterized by high ICU occupancy and escalating costs. To address these challenges, an Integrated Delivery System for PMV patients (PMV-IDS) was implemented in 2000, featuring stepwise care and payment reform. This study aimed to examine longitudinal trends in clinical outcomes and national health indicators associated with the PMV-IDS program. Methods In this retrospective, longitudinal, population-based study, we analyzed aggregate data from patients receiving mechanical ventilation between 2005 and 2023, sourced from the Ministry of Health and Welfare and the National Health Insurance Administration. Patients ventilated for ≥21 consecutive days were defined as PMV; those ventilated for >63 days were considered ventilator-dependent. Trends in weaning success, mortality, ICU resource utilization, and healthcare expenditures were assessed using descriptive statistics and linear regression. Results From 2005 to 2022, newly ventilated patients increased by 15%. The proportion receiving prolonged ventilation (>63 days) decreased from 24% to 15%, and mortality declined from 25% to 18%. The weaning success rate within 21 ventilator days reached 70% in 2022. Mean ICU days decreased, and RCC occupancy stabilized after 2015. Home-based ventilator care increased from 3500 in 2013 to 4700 in 2023. Medical expenditures rose from 25.1 to 30.6 billion points. Conclusions This study describes epidemiological trends and associated healthcare utilization among patients receiving long-term mechanical ventilation under Taiwan's PMV-IDS framework. These findings provide a descriptive benchmark for this population. Given data limitations, future studies are warranted to refine these observations.

BACKGROUND:Colistimethate sodium (CMS) is increasingly being administered as aerosol therapy in mechanically ventilated patients. Although vibrating-mesh nebulizers (VMNs) are commonly used, the impact of repeated high-dose CMS administration on expiratory filter loading and circuit pressure drop has not been well defined. This study evaluated circuit deposition patterns and changes in expiratory filter pressure drop according to the nebulizer position. METHODS:A ventilator with adult settings and heated humidification was connected to an endotracheal tube and test lung. A VMN was positioned either at the Y-adapter or at the humidifier inlet. Two CMS vials (160 mg each) were diluted in 6 mL of saline and nebulized. Fourteen treatments were administered over 7 days in 5 independent experiments per group (no. = 5). Drug deposition was quantified by high-performance liquid chromatography. Pressure drop, defined as the difference between upstream and downstream pressure across the expiratory high-efficiency particulate air filter, was measured over repeated administrations and analyzed using a mixed repeated-measures model. RESULTS:The nebulizer position significantly altered deposition within the ventilator circuit. Placement at the Y-adapter resulted in greater exhalation valve deposition (28.35 ± 4.83 mg vs 5.83 ± 1.51 mg, P < .001) and increased pressure drop over time. A significant time-by-position interaction was observed (P = .01), with higher pressure drop after 14 treatments. In contrast, humidifier-inlet placement was associated with greater drug accumulation within the humidifier chamber (35.59 ± 6.21%) and a smaller increase in pressure drop. CONCLUSIONS:During repeated high-dose CMS administration, the nebulizer position influenced circuit deposition patterns and expiratory filter pressure drop. Placement at the Y-adapter was associated with greater expiratory limb deposition and increased filter pressure drop over time, whereas humidifier-inlet placement shifted the drug accumulation proximally within the circuit.

INTRODUCTION:The diagnostic yield of mycobacterial culture from pleural tissue in tuberculous pleurisy is high and practical. However, the yield rates of mycobacterial culture from pleural tissue obtained through different pleural biopsy techniques via medical pleuroscopy remain unclear. This study aimed to compare the efficiency of mycobacterial culture from pleural tissue obtained by cryobiopsy and forceps biopsy during medical pleuroscopy for diagnosing tuberculous pleurisy. METHODS:This retrospective study included 84 patients with tuberculous pleurisy who underwent mycobacterial culture testing using pleural tissue samples. Of these, 33 patients underwent pleuroscopic cryobiopsy and 51 underwent pleuroscopic forceps biopsy from April 2016 to December 2023 at two tertiary hospitals. Mycobacterial cultures from pleural tissue obtained by cryobiopsy and forceps biopsy were analyzed. RESULTS:The average age of the participants was 67.1 years, with 67.9% being men. The sensitivity of Mycobacterium tuberculosis (MTB) cultures from pleural tissue was 54.5% (18/33) for cryobiopsy and 62.7% (32/51) for forceps biopsy (p = 0.455). The sensitivity of MTB culture was higher, up to 64.4% and 74.2%, in cases with pleural adhesion lesions and a combination of adhesion lesions and micronodules, respectively. CONCLUSION:There was no significant difference in the yield rate of MTB culture obtained by cryobiopsy or forceps biopsy in cases of undiagnosed pleural effusion during pleuroscopy. When tuberculous pleurisy is suspected, forceps biopsy may be the optimal method for obtaining mycobacterial cultures from pleural tissue.

PURPOSE:Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening opportunistic infection. Recent studies have demonstrated a poor prognosis and higher mortality rate in non-human immunodeficiency virus (HIV) patients, with associated risk factors including cytomegalovirus (CMV) co-infection. We aimed to investigate the outcomes of concomitant PJP and CMV infection in non-HIV mechanically ventilated critically ill patients. PATIENTS AND METHODS:We retrospectively enrolled adult patients admitted to an intensive care unit (ICU) and diagnosed with PJP infection from January 2017 to December 2022. Data were retrieved from the Chang Gung Research Database, including clinical manifestations, comorbidities and mortality. RESULTS:A total of 132 adult patients without HIV infection received mechanical ventilation in the ICU, underwent bronchoalveolar lavage and diagnosed with PJP were enrolled, of whom 26 patients had concomitant CMV infection and 106 did not. The PJP and concomitant CMV infection group had a significantly lower PaO2/FiO2 ratio (73.5 vs. 95.6, p = 0.04) and higher procalcitonin level (2.2 ng/ml vs. 0.4 ng/ml, p = 0.004). While CMV co-infection was associated with higher ICU mortality in the univariate analysis (33.3% vs. 11.1%, p = 0.002), multivariate analysis revealed that systemic CMV co-infection was not an independent predictor of mortality. Instead, the extended model demonstrated that mortality was significantly associated with acute respiratory distress syndrome (ARDS) (HR 4.281, 95% CI:1.178-15.565, p = 0.027) and the duration of PJP treatment (HR: 0.892, 95% CI: 0.803-0.990, p = 0.006). CONCLUSION:Concomitant CMV infection was about one-fifth in the non-HIV critically ill patients with PJP infection but does not independently increase mortality risk. Clinical management should prioritize early, sustained anti-pneumocystis therapy and lung-protective strategies for ARDS.

Infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) are increasingly contributing to mortality in ICU patients. The study aimed to evaluate outcomes, identify mortality predictors, and assess antibiotic strategies for treating KPC-Kp bloodstream infections (BSIs) in critically ill ICU patients. This retrospective study at Chang Gung Memorial Hospital, Taiwan, from January 2017 to December 2021, analyzed 168 adult ICU patients with KPC-Kp BSIs. All patients experienced respiratory failure and were on mechanical ventilation. The 30-day mortality rate was 61.9

The association between influenza infection and thromboembolism (TE) events, including cardiovascular events, cerebrovascular events, pulmonary embolism, and deep vein thrombosis, is supported by compelling evidence. However, there is a disparity in the risk factors that impact the outcomes of severe influenza-complicated TE in intensive care unit (ICU) patients. The objective of this study was to evaluate the outcomes of severe influenza-complicated TE in ICU patients and identify any associated risk factors. METHODS:A retrospective cohort study was conducted, recruiting consecutive patients with TE events admitted to the ICU between December 2015 through December 2018 at our institution in Taiwan. The study included a group of 108 patients with severe influenza and a control group of 192 patients with severe community-acquired pneumonia. Associations between complicated TE, length of ICU stay, and 90-day mortality were evaluated using logistic regression analysis, and risk factors were identified using univariate and multivariate generalized linear regression analyses. RESULTS:TE event prevalence was significantly higher in ICU patients with severe influenza than in ICU patients with severe CAP (21.3% vs. 5.7%, respectively; p < 0.05). Patients with severe influenza who developed TE experienced a significant increase in the ratio of mechanical ventilation use, length of mechanical ventilation use, ICU stay, and 90-day mortality when compared to patients without TE (all p < 0.05). The comparison of severe CAP patients with and without TE revealed no significant differences (p > 0.05). The development of thromboembolic events in patients with severe influenza or severe noninfluenza CAP is linked to influenza infection and hypertension (p < 0.05). Furthermore, complicated TE and the severity of the APACHE II score are risk factors for 90-day mortality in ICU patients with severe influenza (p < 0.05). CONCLUSIONS:Patients with severe influenza and complicated TE are more likely to have an extended ICU stay and 90-day mortality than patients with severe CAP. The risk is significantly higher for patients with a higher APACHE II score. The results of this study may aid in defining better strategies for early recognition and prevention of severe influenza-complicated TE.

Background: Impaired systemic tissue oxygenation and microvascular perfusion are associated with adverse outcomes in patients with acute respiratory distress syndrome (ARDS). Tissue oxygenation and microvascular reactivity, assessed by using near-infrared spectroscopy (NIRS), are correlated with disease severity in critically ill populations. This study aimed to detect alterations in these factors and their ability to predict outcomes in patients with ARDS. Methods: We performed NIRS measurements on the first (Day 1) and third (Day 3) days after ARDS diagnosis in 29 patients. We recorded the baseline forearm muscle oxygen saturation (StO2) and calculated the deoxygenation slope (Deoxy) and reoxygenation (Reoxy) slope. We divided the subjects into 28-day survival and non-survival subgroups to compare microcirculatory and oxygenation status differences. Results: The Day 1 StO2 values were significantly higher for the survival subgroup (60.1 ± 13.5%) than the non-survival subgroup (47.2 ± 6.9%) (p = 0.025). The ROC curve showed that Day 1 StO2 was a significant predictor of 28-day mortality (p = 0.025). There was no significant difference between the Deoxy and Reoxy slopes of the two groups (p > 0.05). The ROC of the Day 1 Reoxy slope for survival prediction (AUC0.74) was not statistically significant (p = 0.074). Conclusions: Our study showed poor survival outcomes in patients who had lower skeletal muscle StO2 values in early-stage ARDS. NIRS measurements may provide prognostic value for the survival outcomes in patients with this syndrome.

Abstract Background Infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp), particularly blood-stream infections (BSIs), are increasingly emerging as contributors to mortality in intensive care unit (ICU) patients. The challenge in treating KPC-Kp induced BSIs lies in the difficulty of providing early active antibiotic therapy and limited number of effective antibiotics available. The aim of this study was to identify predictive factors for mortality in critically ill ICU patients with KPC-Kp induced BSIs. Materials and Methods This retrospective study included the data of adult patients who had KPC-Kp induced BSIs and were admitted to the ICU of Chang Gung Memorial Hospital, Taoyuan, Taiwan, during the period from January 2017 to December 2021. All patients experienced respiratory failure and were on mechanical ventilation. We analyzed the outcomes in the patients with KPC-Kp induced BSIs. Results We included 168 patients with KPC-Kp BSIs during the study period. The 30-day mortality rate was 61.9%. Compared with the patients who survived, those who died had a higher Pitt bacteremia score (7.0 ± 2.6 vs 4.2 ± 2.9, P < 0.001), higher sequential organ failure assessment (SOFA) score (12.0 ± 4.1 vs6.2 ± 3.8, p < 0.001), a greater need for continuous renal replacement therapy (27.9% vs 9.4%, P < 0.002), and a higher prevalence of intra-abdominal infections (9.6% vs 0%, P < 0.001). In addition, patients who died within 30 days had lower platelets counts (93.7 ± 84.7 vs 171.1 ± 120.2, P < 0.001) and higher C-reactive protein (CRP) levels (131.3 ± 92.3 vs 88.7 ± 81.0, P < 0.003). Our multivariate analysis revealed that CRP levels and SOFA scores were independently associated with mortality, whereas treatment with a Ceftazidime-Avibactam based regimen and appropriate antibiotic treatment within 48 hours after BSIs onset were independently associated with favorable outcome. Conclusions Appropriate antibiotic treatments within 48 hours after BSIs onset and Ceftazidime-Avibactam treatment are crucial for reducing mortality among critically ill ICU patients.

Dual bronchodilator therapy, consisting of a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), has proven effective for patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain whether there are efficacy differences between current and former smokers with COPD. This study aims to explore the effectiveness of LABA/LAMA therapies in both these groups. The TOReTO trial assessed lung function, symptoms, health status, the occurrence of exacerbations, clinically significant exacerbations, and the use of LABA/LAMA therapies. These therapies include Tio/Olo, umeclidinium/vilanterol (Umec/Vi), and umeclidinium/vilanterol (Umec/Vi) are used in patients with COPD. The study examined the differences in outcomes between current and former smokers. To balance the baseline characteristics, propensity score matching (PSM) was employed. Data from 967 patients were collected. After PSM, the time to the first acute exacerbation in current smokers was analyzed separately for the three treatment groups and was significantly different between them (p = 0.0457). Among, there are differences in the occurrence of acute exacerbation between treatment and smoking status in Umec/Vi (p = 0.0114). There is no significant difference in the treatment of former smokers among the three different groups of LABA/LAMA fixed-dose combinations (p = 0.3079). COPD-related symptoms remained stable throughout the treatment period. There were no significant differences in symptom scores, including CAT and mMRC, among the three groups at the end of the study. The three fixed-dose combinations of LABA/LAMA showed no difference in reducing exacerbations in former smokers but did show differences in current smokers. This trend has clinical significance, and future research will be conducted to control influencing variables to validate this point. However, due to the non-randomized study design, these findings should be interpreted with caution.

Background Positive fluid balance and tissue fluid accumulation are associated with adverse outcomes in sepsis. Vascular endothelial growth factor (VEGF) increases in sepsis, promotes vascular permeability, and may affect tissue fluid accumulation and oxygenation. We used near-infrared spectroscopy (NIRS) to estimate tissue hemoglobin (Hb) oxygenation and water (H 2 O) levels to investigate their relationship with serum VEGF levels. Material and methods New-onset severe sepsis patients admitted to the intensive care unit were enrolled. Relative tissue concentrations of oxy-Hb ( [HbO 2 ] ), deoxy-Hb ( [HbR] ), total Hb ( [HbT] ), and H 2 O ( [H 2 O] ) were estimated by near-infrared spectroscopy (NIRS) for three consecutive days and serum VEGF levels were measured. Comparisons between oliguric and non-oliguric patients were conducted and the correlations between variables were analyzed. Results Among 75 eligible patients, compared with non-oliguric patients, oliguric patients were administrated more intravascular fluids (median [IQR], 1926.00 [1348.50–3092.00] mL/day vs. 1069.00 [722.00–1486.75] mL/day, p < 0.001) and had more positive daily net intake and output (mean [SD], 1,235.06 [1303.14] mL/day vs. 313.17 [744.75] mL/day, p = 0.012), lower [HbO 2 ] and [HbT] over the three-day measurement (analyzed by GEE p = 0.01 and 0.043, respectively) and significantly higher [H 2 O] on the third day than on the first two days (analyzed by GEE p = 0.034 and 0.018, respectively). Overall, serum VEGF levels were significantly negatively correlated with [HbO 2 ] and [HbT] (rho = − 0.246 and − 0.266, p = 0.042 and 0.027, respectively) but positively correlated with [H 2 O] (rho = 0.449, p < 0.001). Subgroup analysis revealed a significant correlation between serum VEGF and [H2O] in oliguric patients (rho = 0.532, p = 0.003). Multiple regression analysis determined the independent effect of serum VEGF on [H 2 O] (standardized coefficient = 0.281, p = 0.038). Conclusions In severe sepsis, oliguria relates to higher positive fluid balance, lower tissue perfusion and oxygenation, and progressive tissue fluid accumulation. Elevated serum VEGF is associated with worsening tissue perfusion and oxygenation and independently affects tissue fluid accumulation.

Background: Long-acting beta-agonists (LABA) and long-acting muscarinic antagonists (LAMA) combination therapy improved lung function and health-related quality-of-life and reduced exacerbation rates and dyspnea in symptomatic chronic obstructive pulmonary disease (COPD) patients. We compared the real-world effects of three fixed-dose LABA/LAMA combinations for COPD in Taiwan. Methods: This multicenter, retrospective study evaluated 1-year outcomes after LABA/LAMA combination therapy in patients with symptomatic COPD. Exacerbations and symptoms of COPD, lung functions, and therapy escalation were compared among patients using tiotropium/olodaterol, umeclidinium/vilanterol and indacaterol/glycopyrronium. Propensity score matching (PSM) was applied to balance the baseline characteristics. Results: Data of 1,617 patients were collected. After PSM, time to first moderate-to-severe COPD exacerbation was comparable among three groups, while the annualized rates of the exacerbation (episodes/patient/year) in patients receiving tiotropium/olodaterol (0.19) or umeclidinium/vilanterol (0.17) were significantly lower than those receiving indacaterol/glycopyrronium (0.38). COPD-related symptoms were stable over the treatment period, and there was no significant difference in the changes of symptom scores including CAT and mMRC among three groups at the end of the study period. Conclusion: This study presented valuable real-world outcome in terms of exacerbation and treatment response of COPD patients treated with fixed-dose LABA/LAMA regimens in Taiwan. The annualized rates of moderate-to-severe exacerbation in patients receiving tiotropium/olodaterol or umeclidinium/vilanterol were significantly lower than those receiving indacaterol/glycopyrronium, though the time to first moderate-to-severe exacerbation was similar among different fixed-dose LABA/LAMA combinations.

Critically ill patients, such as those in intensive care units (ICUs), can develop herpes simplex virus (HSV) pneumonitis. Given the high prevalence of acute respiratory distress syndrome (ARDS) and multiple pre-existing conditions among ICU patients with HSV pneumonitis, factors predicting mortality in this patient population require further investigation. In this retrospective study, the bronchoalveolar lavage or sputum samples of ICU patients were cultured or subjected to a polymerase chain reaction for HSV detection. Univariable and multivariable Cox regressions were conducted for mortality outcomes. The length of hospital stay was plotted against mortality on Kaplan–Meier curves. Among the 119 patients with HSV pneumonitis (age: 65.8 ± 14.9 years), the mortality rate was 61.34% (73 deaths). The mortality rate was significantly lower among patients with diabetes mellitus (odds ratio [OR] 0.12, 95% confidence interval [CI]: 0.02–0.49, p = 0.0009) and significantly higher among patients with ARDS (OR: 4.18, 95% CI: 1.05–17.97, p < 0.0001) or high (≥30) Acute Physiology and Chronic Health Evaluation II scores (OR: 1.08, 95% CI: 1.00–1.18, p = 0.02). Not having diabetes mellitus (DM), developing ARDS, and having a high Acute Physiology and Chronic Health Evaluation II (APACHE II) score were independent predictors of mortality among ICU patients with HSV pneumonitis.

Oxygen pulse (O2P) is a function of stroke volume and cellular oxygen extraction and O2P curve pattern (O2PCP) can provide continuous measurements of O2P. However, measurements of these two components are difficult during incremental maximum exercise. As cardiac function is evaluated using ejection fraction (EF) according to the guidelines and EF can be obtained using first-pass radionuclide ventriculography, the aim of this study was to investigate associations of O2P%predicted and O2PCP with EF in patients with heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) and chronic obstructive pulmonary disease (COPD), and also in normal controls. This was a prospective observational cross-sectional study. Correlations of resting left ventricular EF, dynamic right and left ventricular EFs and outcomes with O2P% and O2PCP across the three participant groups were analyzed. A total of 237 male subjects were screened and 90 were enrolled (27 with HFrEF/HFmrEF, 30 with COPD and 33 normal controls). O2P% and the proportions of the three types of O2PCP were similar across the three groups. O2P% reflected dynamic right and left ventricular EFs in the control and HFrEF/HFmrEF groups, but did not reflect resting left ventricular EF in all participants. O2PCP did not reflect resting or dynamic ventricular EFs in any of the subjects. A decrease in O2PCP was significantly related to nonfatal cardiac events in the HFrEF/HFmrEF group (log rank test, p = 0.01), whereas O2P% and O2PCP did not predict severe acute exacerbations of COPD. The findings of this study may clarify the utility of O2P and O2PCP, and may contribute to the currently used interpretation algorithm and the strategy for managing patients, especially those with HFrEF/HFmrEF. (Trial registration number NCT05189301.).

Prolonged mechanical ventilation (PMV) is associated with poor outcomes and a high economic cost. The association between protein intake and PMV has rarely been investigated in previous studies. This study aimed to investigate the impact of protein intake on weaning from mechanical ventilation. Patients with the PMV (mechanical ventilation ≥6 h/day for ≥21 days) at our hospital between December 2020 and April 2022 were included in this study. Demographic data, nutrition records, laboratory data, weaning conditions, and survival data were retrieved from the patient’s electronic medical records. A total of 172 patients were eligible for analysis. The patients were divided into two groups: weaning success (n = 109) and weaning failure (n = 63). Patients with daily protein intake greater than 1.2 g/kg/day had significant shorter median days of ventilator use than those with less daily protein intake (36.5 vs. 114 days, respectively, p < 0.0001). Daily protein intake ≥1.065 g/kg/day (odds ratio: 4.97, p = 0.033), daily protein intake ≥1.2 g/kg/day (odds ratio: 89.07, p = 0.001), improvement of serum albumin (odds ratio: 3.68, p = 0.027), and BMI (odds ratio: 1.235, p = 0.014) were independent predictor for successful weaning. The serum creatinine level in the 4th week remained similar in patients with daily protein intake either >1.065 g/kg/day or >1.2 g/kg/day (p = 0.5219 and p = 0.7796, respectively). Higher protein intake may have benefits in weaning in patients with PMV and had no negative impact on renal function.

Purposes: This study investigated the prevalence and clinical outcomes of pulmonary bacterial co-infections and secondary bacterial infections in patients with severe influenza pneumonitis. Methods: We retrospectively analyzed the data of adult patients with severe influenza pneumonitis admitted to medical ICUs. Bacterial co-infections and secondary bacterial infections were identified. The risk factors of bacte-rial infection were evaluated. The outcomes of patients regarding co-infection or secondary bacterial infection were analyzed.Results: We identified 117 critically ill patients with laboratory-confirmed influenza pneumonitis admitted to the medical ICUs. Klebsiella pneumoniae (31.4%) and Staphylococcus aureus (22.8%) were the most identified bacteria in patients with bacterial co-infection. A high proportion of methicillin-resistant Staphylococcus aureus (17.1%) was noted. Liver cirrhosis and diabetes mellitus were the independent risk factors for bacterial co-infection. Acinetobacter baumannii (30.7%) and S. aureus (23.1%) were the most often identified bacteria in patients with secondary bacterial pneumonia. Patients with secondary bacterial infections had a longer duration of mechanical ventilation, and longer ICU and hospital stay. Conclusions: High rates of drug-resistant bacterial co-infections and secondary bacterial infections were identi-fied in patients with severe influenza pneumonitis requiring ICU care and were associated with more morbidity in these patients.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

IntroductionCentral sleep apnea (CSA) is a common and serious comorbidity mainly occurring in patients with heart failure (HF), which tends to be underdiagnosed and has not been widely studied. Overnight polysomnography (PSG) is the gold standard for diagnosing CSA; however, the time and expense of the procedure limit its applicability. Portable monitoring (PM) devices are convenient and easy to use; however, they have not been widely studied as to their effectiveness in detecting CSA in patients with HF. In the current study, we examined the diagnostic value of PM as a screening tool to identify instances of CSA among patients with HF.MethodsA total of 22 patients under stable heart failure conditions with an ejection fraction of <50% were enrolled. All patients underwent PM and overnight PSG within a narrow time frame. The measurements of the apnea–hypopnea index (AHI), hypopnea index (HI), central apnea index (CAI), and obstructive apnea index (OAI) obtained from PSG, automatic scoring, and manual scoring of PM were recorded. The results obtained from PSG and those from PM (automatic and manual scoring) were compared to assess the accuracy of PM.ResultsAmong the patients, CSA in 11 patients was found by PSG. The AHI measurements performed using manual scoring of PM showed a significant correlation with those performed using PSG (r = 0.69; P = 0.01). Nonetheless, mean AHI measurements showed statistically significant differences between PSG and automatic scoring of PM (40.0 vs. 23.7 events/hour, respectively; P < 0.001), as well as between automatic and manual scoring of PM (23.7 vs. 29.5 events/hour; P < 0.001). Central sleep apnea was detected by PM; however, the results were easily misread as obstructive apnea, particularly in automatic scoring.ConclusionPM devices could be used to identify instances of central sleep apnea among patients with HF. The results from PM were well-correlated with standard PSG results, and manual scoring was preferable to automated scoring.

Background : This study investigated the prevalence and clinical outcomes of pulmonary bacterial coinfections and secondary bacterial pneumonia in patients with severe influenza pneumonitis. The causative pathogens and their clinical impacts were analyzed. Methods : We retrospectively analyzed the data of adult patients with severe influenza pneumonitis admitted to our medical ICUs from January 2014 to May 2018. Bacterial confection (in first 48 h) and secondary bacterial pneumonia (from 48 h to 1 week) were confirmed by chest radiographs and positive findings in the respiratory specimen obtained from lower airway. The risk factors of pulmonary coinfection were evaluated. The outcomes of patients with or without pulmonary coninfection or secondary bacterial pneumonia were also analyzed. Results : We identified 117 critically ill patients with laboratory-confirmed influenza pneumonitis admitted to the medical ICUs. Klebsiella pneumoniae (31.4%) and Staphylococcus aureus (22.8%) were the most commonly identified bacteria in patients with bacterial coinfection. A high proportion of methicillin-resistant Staphylococcus aureus was noted. Liver cirrhosis and diabetes mellitus were the independent risk factors for bacterial coinfection. Acinetobacter baumannii (28%) and S . aureus (25%) were the most often identified bacteria in patients with secondary bacterial pneumonia. Patients with secondary bacterial pneumonia had longer period of mechanical ventilation, longer ICU stay and hospital stay, and higher mortality. Conclusions : Bacterial coinfection or secondary infection in patients with severe influenza pneumonitis were associated with higher rates of morbidity and mortality in ICU patients. Earlier diagnosis and appropriate therapy, especially in patients with liver cirrhosis and diabetes mellitus, should be cautiously considered.

Patients with chronic obstructive pulmonary disease (COPD) have been reported to have poor sleep quality. However, total sleep time has not been evaluated in detail among patients with COPD. This retrospective, observational, multicenter research study was performed across six participating hospitals in Taiwan, with a total of 421 adult patients enrolled. Pulmonary function, the Modified British Medical Research Council Dyspnea Scale, the COPD Assessment Test and basic clinical data were assessed. The Pittsburgh Sleep Quality Index was also administered to patients, and the total sleep time was extracted for further analysis. The patients whose total sleep time was between 6 and 7 h had better pulmonary function, and the patients who slept less than 5 h had worse comorbidities. There was a significant higher total sleep time in Global Initiatives for Chronic Obstructive Lung Disease (GOLD) group B compared to GOLD group A. COPD patients who sleep between 5 and 6 h used fewer oral steroids and were less likely to use triple therapy (long-acting beta-agonist, long-acting muscarinic antagonist, inhaled cortical steroid). COPD patients sleeping from 5 to 7 h had better clinical features than those sleeping less than 5 h in terms of pulmonary function, comorbidities and medication usage.

Mutations that lead to constitutive activation of key regulators in cellular processes are one of the most important drivers behind vigorous growth of cancer cells, and are thus prime targets in cancer treatment. BRAF V600E mutation transduces strong growth and survival signals for cancer cells, and is widely present in various types of cancers including lung cancer. A combination of BRAF inhibitor (dabrafenib) and MEK inhibitor (trametinib) has recently been approved and significantly improved the survival of patients with advanced NSCLC harboring BRAF V600E/K mutation. To improve the detection of BRAF V600E/K mutation and investigate the incidence and clinicopathological features of the mutation in lung cancer patients of southern Taiwan, a highly sensitive and specific real-time quantitative PCR (RT-qPCR) method, able to detect single-digit copies of mutant DNA, was established and compared with BRAF V600E-specific immunohistochemistry. Results showed that the BRAF V600E mutation was present at low frequency (0.65%, 2/306) in the studied patient group, and the detection sensitivity and specificity of the new RT-qPCR and V600E-specific immunohistochemistry both reached 100% and 97.6%, respectively. Screening the BRAF V600E/K mutation with the RT-qPCR and V600E-specific immunohistochemistry simultaneously could help improve detection accuracy.

Background: A nationwide program initiated by Taiwan CDC was conducted by the Taiwan Society of Tuberculosis and Lung Disease to improve the appropriateness of anti-TB prescriptions in Taiwan. Methods: All anti-TB prescriptions from 12 hospitals across Taiwan were reviewed by experienced pulmonologists, according to the 2011 Taiwan TB treatment guidelines, between May and October 2013. The investigation period was divided into three stages: May to June, July to August, and September to October. The concordance rates between anti-TB prescriptions and the guidelines were compared among the three stages and between medical centers and regional hospitals. Results: A total of 2574 new anti-TB prescriptions were reviewed. The appropriateness of anti-TB prescriptions was 82.0%. The most dominant error was inappropriate dosage of anti-TB medications. The appropriateness improved significantly with prescription review, and the concordance rates were 78.7%, 80.6%, and 87.6% in stages 1, 2, and 3, respectively (P < 0.001). The inappropriateness of medication dosage also improved significantly, with the rates of inappropriate dosage dropping from 10.2% in stage 1-5.4% in stage 3 (Odds ratio 0.491, P < 0.001). The appropriateness rates showed no significant difference between regional hospitals and medical centers (82.5% vs. 81.3%, Odds ratio 0.915, P = 0.393), but the improvement of prescription appropriateness was significant in regional hospitals but not in medical centers. Conclusion: Prescription review by TB experts is an effective approach to improve the appropriateness of anti-TB prescriptions. Copyright (C) 2020, Formosan Medical Association. Published by Elsevier Taiwan LLC.