A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.

Background Acute myocardial infarction is believed to be caused by rupture of an unstable coronary-artery plaque that appears as a single lesion on angiography. However, plaque instability might be caused by pathophysiologic processes, such as inflammation, that exert adverse effects throughout the coronary vasculature and that therefore result in multiple unstable lesions. Methods To document the presence of multiple unstable plaques in patients with acute myocardial infarction and determine their influence on outcome, we analyzed angiograms from 253 patients for complex coronary plaques characterized by thrombus, ulceration, plaque irregularity, and impaired flow. Results Single complex coronary plaques were identified in 153 patients (60.5 percent) and multiple complex plaques in the other 100 patients (39.5 percent). As compared with patients with single complex plaques, those with multiple complex plaques were less likely to undergo primary angioplasty (86.0 percent vs. 94.8 percent, P=0.03) and more...

Multiple complex coronary plaques in patients with acute myocardial infarction.

Summary Background Few patients with amyotrophic lateral sclerosis currently receive non-invasive ventilation (NIV), reflecting clinical uncertainty about the role of this intervention. We aimed to assess the effect of NIV on quality of life and survival in amyotrophic lateral sclerosis in a randomised controlled trial. Methods 92 of 102 eligible patients participated. They were assessed every 2 months and randomly assigned to NIV (n=22) or standard care (n=19) when they developed either orthopnoea with maximum inspiratory pressure less than 60% of that predicted or symptomatic hypercapnia. Primary validated quality-of-life outcome measures were the short form 36 mental component summary (MCS) and the sleep apnoea quality-of-life index symptoms domain (sym). Both time maintained above 75% of baseline (T i MCS and T i sym) and mean improvement (μMCS and μsym) were measured. Findings NIV improved T i MCS, T i sym, μMCS, μsym, and survival in all patients and in the subgroup with better bulbar function (n=20). This subgroup showed improvement in several measures of quality of life and a median survival benefit of 205 days (p=0·006) with maintained quality of life for most of this period. NIV improved some quality-of-life indices in those with poor bulbar function, including μsym (p=0·018), but conferred no survival benefit. Interpretation In patients with amyotrophic lateral sclerosis without severe bulbar dysfunction, NIV improves survival with maintenance of, and improvement in, quality of life. The survival benefit from NIV in this group is much greater than that from currently available neuroprotective therapy. In patients with severe bulbar impairment, NIV improves sleep-related symptoms, but is unlikely to confer a large survival advantage.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(05)70326-4.pdf

Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial.

Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

https://erj.ersjournals.com/content/erj/34/1/17.full.pdf

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)

Background: Noninvasive positive-pressure ventilation may benefit patients with amyotrophic lateral sclerosis and respiratory insufficiency. Objective: To determine 1) whether patients tolerant of ...

Effect of noninvasive positive-pressure ventilation on survival in amyotrophic lateral sclerosis.

Exercise testing, 6-min walk, and stair climb in the evaluation of patients at high risk for pulmonary resection.

The Cleveland Clinic's initial experience with transtracheal oxygen therapy

Modification of the Spacer Device: Use in the Patient with Arthritis or an Artificial Airway

Poor survival in pulmonary hypertension is known to be associated with unfavorable hemodynamic variables, including elevated right atrial pressure, elevated mean pulmonary artery pressure, and low cardiac index. However, the effect of plasma volume on outcome has not been evaluated. Our goal was to study the spectrum of plasma volume distribution in patients with pulmonary hypertension and to determine whether plasma volume could provide any prognostic insight in these patients. Our pilot study comprised 11 patients (aged 46 ± 16 years; 7 women) who were undergoing pulmonary artery catheterization before vasodilator therapy. In all 11 patients, plasma volume was measured, with use of <25 µCi 131 I-radioiodinated serum albumin. Patient follow-up averaged 19 months. There were 2 deaths. The 2 patients who died had the highest right atrial pressures in the group: ≥17 mmHg. Those 2 patients also had 2 of the 3 highest plasma volumes at ≥8.4%. None of the patients underwent lung transplantation. The propensity for elevated plasma volume and right atrial pressure in patients who died in this pilot study is consistent with the advanced right-sided heart failure that occurs in the terminal stages of pulmonary hypertension. Elevated plasma volume may be a useful prognosticator; further studies are needed to assess whether manipulation of plasma volume affects prognosis. (Tex Heart Inst J 2003;30:305-7)

/pdf/plasma-volume-and-outcome-in-pulmonary-hypertension-1mj9zvmn35.pdf

Kay Stelmach

Papers

Effect of noninvasive positive-pressure ventilation on survival in amyotrophic lateral sclerosis.

Exercise testing, 6-min walk, and stair climb in the evaluation of patients at high risk for pulmonary resection.

The Cleveland Clinic's initial experience with transtracheal oxygen therapy

Modification of the Spacer Device: Use in the Patient with Arthritis or an Artificial Airway

Plasma volume and outcome in pulmonary hypertension.