The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published the complete 2023 GOLD report, which can be freely downloaded from its web page ([www.goldcopd.org][1]) together with a “pocket guide” and “teaching slide set” [1]. It contains important changes compared to earlier versions, and incorporates 387 new references [1]. Here, we present an executive summary of this GOLD 2023 report [1] that summarizes aspects that a) are relevant from a cliniciańs perspective and b) updates evidence published since the prior executive summary in 2017. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. [1]: http://www.goldcopd.org 

Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary

University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA University of Exeter Medical School College of Medicine and Health University of Exeter, Exeter, Devon, UK South Texas Veterans Health Care System University of Texas, Health San Antonio, Texas, USA National Heart & Lung Institute Imperial College London, UK McGill University Health Centre McGill University Montreal, Canada University of Michigan, Ann Arbor, Michigan, USA Weill Cornell Medical Center/ New York-Presbyterian Hospital New York, New York, USA Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/resp.14486

Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary.

Intraoperative neurophysiological monitoring involves electrical stimulation of nerve pathways and is used to assess the integrity of both motor and sensory pathways. Whereas motor pathway monitoring involves transcranial stimulation and peripheral nerve monitoring, somatosensory monitoring involves peripheral nerve stimulation and cranial monitoring. Arrhythmias are a known complication of motor-evoked potential monitoring but have not been reported with somatosensory monitoring. We describe a case of bradycardic arrest with somatosensory-evoked potential monitoring using median nerve electrodes in a patient with no previous rhythm abnormality. Clinicians caring for patients receiving somatosensory monitoring should be aware of the potential for severe arrhythmias.

Bradycardic Arrest During Somatosensory-Evoked Potential Monitoring: A Case Report.

High-flow nasal cannula (HFNC) can improve ventilatory function in patients with acute COPD exacerbation. However, its effect on clinical outcomes remains uncertain.This randomized controlled trial was conducted from July 2017 to December 2020 in 16 tertiary hospitals in China. Patients with acute COPD exacerbation with mild hypercapnia (pH ≥ 7.35 and arterial partial pressure of carbon dioxide > 45 mmHg) were randomly assigned to either HFNC or conventional oxygen therapy. The primary outcome was the proportion of patients who met the criteria for intubation during hospitalization. Secondary outcomes included treatment failure (intolerance and need for non-invasive or invasive ventilation), length of hospital stay, hospital cost, mortality, and readmission at day 90.Among 337 randomized patients (median age, 70.0 years; 280 men [83.1%]; median pH 7.399; arterial partial pressure of carbon dioxide 51 mmHg), 330 completed the trial. 4/158 patients on HFNC and 1/172 patient on conventional oxygen therapy met the criteria for intubation (P = 0.198). Patients progressed to NPPV in both groups were comparable (15 [9.5%] in the HFNC group vs. 22 [12.8%] in the conventional oxygen therapy group; P = 0.343). Compared with conventional oxygen therapy, HFNC yielded a significantly longer median length of hospital stay (9.0 [interquartile range, 7.0-13.0] vs. 8.0 [interquartile range, 7.0-11.0] days) and a higher median hospital cost (approximately $2298 [interquartile range, $1613-$3782] vs. $2005 [interquartile range, $1439-$2968]). There were no significant differences in other secondary outcomes between groups.In this multi-center randomized controlled study, HFNC compared to conventional oxygen therapy did not reduce need for intubation among acute COPD exacerbation patients with mild hypercapnia. The future studies should focus on patients with acute COPD exacerbation with respiratory acidosis (pH < 7.35). However, because the primary outcome rate was well below expected, the study was underpowered to show a meaningful difference between the two treatment groups.NCT03003559 . Registered on December 28, 2016. 

/pdf/high-flow-nasal-cannula-versus-conventional-oxygen-therapy-2a6i4bsn.pdf

High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial

This is a case report of an episode of acute bradycardia following intraoperative transcranial electric motor evoked potential (tc e MEP) stimulation. Review of the literature showed no reported cases of induced bradycardia as a result of tc e MEP stimulation during surgery. Our patient underwent anterior cervical discectomy and fusion of the C3 and C4 intervertebral space to treat cervical stenosis. During the procedure, a significant drop in heart rate was detected immediately following tC e MEP stimulation. The heart rate of the patient slowly returned to baseline normal sinus rhythm and showed no further arrhythmia within minutes of stimulation. The consequences of profound or sudden bradycardia may cause symptoms such as loss of energy, weakness, and fainting attacks in the conscious patient. Intraoperatively, under general anesthesia, profound bradycardia can result in hypotension and decreased cardiac output. An awareness of the possibility of this finding during intraoperative tc e MEP monitoring should facilitate a timely anesthesia team intervention, when necessary.

Cheng Tao

Papers

High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial

Acute Bradycardia as a Result of Intraoperative Transcranial Electric Motor Evoked Potential Stimulation: A Case Report