Background A large number of symptomatic individuals with central sleep apnea (CSA) in clinical practice have an indication for adaptive servo-ventilation (ASV) therapy. Research Question What are the effects of ASV therapy on sleep quality and PROMs in patients with CSA across a range of devices and indications. Methods This prospective, multicenter, observational cohort study was conducted in France and enrolled participants from June 2017 to February 2020. Adults with predominant CSA at diagnosis or obstructive sleep apnea with central events not controlled with continuous positive airway pressure who had an indication for ASV were eligible. Participants attended clinic visits at baseline, and after 1, 3, 6 and 12 months of follow-up. The primary endpoint was the change in Pittsburgh Sleep Quality Index (PSQI) score from baseline to 6-month follow-up (evaluated using a Wilcoxon signed rank test on paired data). Results We included 526 individuals (median age 69 years, 88.2% male). The indication for ASV included CSA with cardiovascular/neurologic etiology (38.4%), treatment-emergent CSA (36.1%), idiopathic CSA (14.1%) or drug-induced CSA (11.4%). At 6-month follow-up, study participants were using ASV for a median of 6.1 h/night. The median [interquartile range] change in the PSQI score from baseline to 6 months in the overall study population was –1 [–3; 0] (p<0.001), with significant results across all indications for ASV except for drug-induced CSA, where the median change was similar to the overall result but did not achieve statistical significance (–1 [–2; 1]; p=0.0866). Overall, 65% of participants had a ≥1-point improvement in the PSQI. Interpretation Individuals with a clinical indication for ASV therapy experienced improved sleep quality during real-world treatment, irrespective of which ASV device was used.

FACIL-VAA est une cohorte prospective multicentrique de SACS éligibles pour un traitement par VAA. Elle collectera des données cliniques en vie réelle depuis le début de l’étude jusqu’à 7 ans de suivi. Au total, 541 patients (11,8 % de femmes) ont été prospectivement inclus. Les patients avec une FEVG ≤ 45 % n’ont pas été inclus. Le SACS était défini par un IAH > 15/h et au moins 50 % d’événements respiratoires centraux par polysomnographie ou polygraphie. Les patients ont été traités par l’une des trois marques d’VAA existantes, selon les préférences des prescripteurs. L’objectif principal était le changement de l’indice de qualité du sommeil de Pittsburgh (PSQI) à 6 mois. L’analyse en ITT porte sur 526 patients, dont 11,8 % de femmes. L’âge médian et l’IMC étaient respectivement de 69 [59 ; 76] ans et 28 [26 ; 32] kg/m2. Les patients présentaient un SACS sévère avec un IAH, IDO et T90 médians respectivement de 44 [31,8 ; 60] et 38 [21,7 ; 54,3] par heure et 16,2 [2,1 ; 53,5] minutes. Les comorbidités pouvant avoir participé à l’étiologie du SACS étaient cardiologiques, neurologiques ou médicamenteuses chez 237 (45,1 %), 105 (20 %) et 35 (6,9 %) patients. Le SACS n’était associé à aucune pathologie chez 125 (23,8 %) et liée à un SACS émergent par CPAP chez 119 (22,6 %) patients. Soixante-trois pour cent des patients amélioraient le PSQI passant de 8 [5 ; 12] à 6 [4 ; 10], p < 0,0001. Cette amélioration était significative pour toutes les étiologies, à l’exception des médicamenteuses. Ce résultat confirme l’efficacité de la VAA et le diagnostic exact du SACS détermine la réponse du PSQI au traitement.

Introduction: After hospital discharge following an acute exacerbation of COPD (AECOPD), remote patient monitoring (RPM) can prevent readmissions [1] by alerting healthcare professionals when vital signs exceed some limits. Objectives: Compare the performance of different vital signs alert configurations in early detection of readmission. Methods: Breath rate (BR), heart rate (HR) and SpO2 of COPD patients were monitored by Bora Care RPM solution during hospitalization for AECOPD and 30 days after discharge. Results: 21 COPD patients (GOLD grade: 9.5% I, 19% II, 33% III, 24% IV; mean age 67 years) were monitored for an average session duration of 37 days (SD 11 days), 5 patients (23.8%) were readmitted. The area under the curve (AUC) of the Receiver Operating Characteristic curve (ROC) was computed to rank the performance of several alert rules on 1) fixed thresholds and 2) variable thresholds based on deviation of the last 48-hour median value from a 15-day baseline. The variable threshold applied simultaneously to SpO2, HR and BR is the best performing alert (AUC=0.84), followed by the fixed threshold applied to SpO2, HR and BR (0.82) and the variable threshold applied to HR only (0.76). Conclusion: Early detection of a patient9s risk of readmission is optimized when SpO2, HR and BR all exceed variable thresholds derived from the patient9s 15-day baseline. [1] Brinchault, G., et al. Rev Mal Resp 15.1 (2023): 70

Backgrounds: High flow nasal cannula (HFNC) is an alternative therapy for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed first to describe outcomes of patients suffering from COVID-19-related ARDS treated with HFNC; secondly to evaluate safety of HFNC (patients and healthcare workers) and compare patients according to respiratory outcome. Methods: A retrospective cohort was conducted in French general hospital intensive care unit (ICU). Patients were included if receiving HFNC for hypoxemia (saturation pulse oxygen (SpO2) <92% under oxygen ⩾6 L/min) associated with ARDS and positive SARS-CoV-2 polymerase chain reaction (PCR). Main clinical characteristics and outcomes are described in patients: (a) with do not intubate order (HFNC-DNIO); (b) who did not need intubation (HFNC-only); and (c) eventually intubated (HFNC-intubation). Medians are presented with (1st–3rd) interquartile range. Results: From 26 February to 30 June 2020, 46 patients of median age 75 (70–79) years were included. In the HFNC-DNIO group (n = 11), partial arterial oxygen pressure (PaO2)/inhaled fraction of oxygen (FiO2) ratio median worst PaO2/FiO2 ratio was 109 (102–172) and hospital mortality was 54.5%. Except the HFNC-DNIO patients (n = 35), 20 patients (57%) were eventually intubated (HFNC-intubation group) and 15 were only treated by HFNC (HFNC-only). HFNC-intubation patients presented higher worst respiratory rates per minute in ICU [37 (34–41) versus 33 (24–34) min, p < 0.05] and worsened ICU admission PaO2/FiO2 ratios [121 (103–169) versus 191 (162–219), p < 0.001] compared with HFNC-only patients. Hospital mortality was 35% (n = 7/20) in HFNC-intubation group, 0% in HFNC-only group with a global mortality of these two groups of 20% (n = 7/35). Among tests performed in healthcare workers, 1/12 PCR in symptomatic healthcare workers and 1.8% serologies in asymptomatic healthcare workers were positive. After review of each case, COVID-19 was likely to be acquired outside hospital. Conclusions: HFNC seems to be useful for COVID-19-related ARDS and safe for healthcare workers. ARDS severity with PaO2/FiO2 <150 associated with respiratory rate >35/min could be regarded as a predictor of intubation. The reviews of this paper are available via the supplemental material section.

The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), now recognised by the World Health Organization as a pandemic, emerged in late 2019 in China [1]. Patients infected with SARS-CoV-2 can develop severe pneumonia and respiratory failure, which often require treatment in intensive care units (ICU) in Western European countries [2]. Oxygen therapy and supportive care are still the main forms of therapy for SARS-CoV-2 pneumonia until suitable anti-infective therapies become available. SARS-CoV-2 infected patients with nonhypercapnic acute hypoxaemic respiratory failure can benefit from high-flow nasal oxygen outside an ICU. The technique appears to be safe for healthcare workers and could well liberate critical ICU resources. https://bit.ly/2Xq80iu

Idiopathic pulmonary fibrosis (IPF) is a chronic fibrosing interstitial lung disease with a poor prognosis. The impact of malnutrition, especialy fat-free mass (FFM), on mortality is scarcely assessed in IPF patients. This study aimed at identifying factors associated with higher mortaliy in IPF. Nutritional status of 185 consecutive IPF patients from a referal Centre were prospectively evaluated by bioelectrical impedancemeter analysis (BIA) to measure FFM, body mass index (BMI), mid-arm circumference, triceps skinfold thickness, food intake analogue visual scale and biology. Malnutrition was defined as a FFM index (FFMI) <15 in women and <17 in men. Stepwise logistic regressions were performed to identify the factors associated with mortality. Malnutrition prevalence was 28% (52/185). IPF patients with low FFMI had higher mortality compared to patients with normal FFMI (p=0.015). In multivariable analyses, factors independently associated with mortality were active cancer, FFMI and BMI. IPF patients with malnutrition have higher mortality. FFMI and BMI are independently associated with mortality. Nutritional status assessment should be systematic in IPF patients. Further studies should aim at assessing wether a dedicated intervention to improve nutritional status would improve IPF patients’ prognosis. NB: We will add 6 more months of follow up for the presentation in September.

Treatment of large spontaneous pneumothoraces requires drainage and, frequently, admission to the hospital. It is possible to treat these patients with exclusive ambulatory management. Efficacy and safety of these two approaches have never been directly compared. Methods: Patients with large primary spontaneous pneumothorax (PSP) or a secondary one (SSP) requiring thoracic drainage were prospectively included in 11 French hospitals. The study compared the « ambulatory » group with a 8.5F catheter linked to a one-way valve, to the « hospitalization » group with the drainage usually used in the ward. The main outcome was success within a week defined as complete or near complete lung re-expansion on chest X-ray (CXR). Results: 213 patients have been included between December 2013 and September 2017, 13.6% of them being SSP. The groups were similar on admission. Only 16% (n=32/197) of the necessary number of patients has been reached in the « hospitalization » group. The success within 7 days was 79.0% [72.3%-84.7%] in the « ambulatory » group and 81.3% [63.6%-92.8%] in the « hospitalization » group (p=0.7725). Success rate was lower with the SSP compared to PSP independently of the group: 55.2% versus 83.2%. Complications were less frequent in the « ambulatory » group (11.0% versus 34.4%, p=0.002) and no death was observed. Level 3 analgesics consumption was lower in the « ambulatory » group (11.3% versus 31.3%, p=0.01), as well as the number of CXR (3.8 versus 5.5, p<0.0001). Ambulatory management of spontaneous pneumothoraces using a one-way valve has the same rate of success compared to hospital care and reduces risk of complications.

Aspiration is a rare complication of video-capsule endoscopy. We report a case of asymptomatic aspiration of the capsule in a 90-year-old man. The diagnosis was obtained by the images taken by the capsule. Rigid bronchoscopy was used to remove the capsule. Recommendations to prevent this complication are: (1) Patients with swallowing disorders should have the capsule placed into the duodenum at the time of upper endoscopy. The capsule should never be placed in the stomach because of prolonged emptying times following endoscopy and IV sedation. (2) If a patient appears to have difficulty swallowing the capsule after two or three attempts, the capsule should be placed endoscopically. (3) When real-time capsule location is more readily available, the abdomen can be scanned after the initial ingestion to be sure that the capsule reached the stomach.