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Annali Di Igiene : Medicina Preventiva... 2016Any work activity performed at elevations over 3,000 m above sea level is considered as work at high altitude. The changing environmental conditions result in an... (Review)
Review
Any work activity performed at elevations over 3,000 m above sea level is considered as work at high altitude. The changing environmental conditions result in an adaptation of the human organism, mainly due to a reduced partial pressure of oxygen in the air and a proportional decrease in barometric pressure. We carried out a systematic review of the scientific literature in this field so as to develop a health and risk protocol as well as a procedure of ascent for researchers and staff expected to work in a science research lab at an altitude of 5,100 m asl. We wish to highlight the crucial role that occupational medicine plays in the formulation of a medical protocol used to assess the suitability of staff to work in environments posing high risks to human health, as in this case, and of a protocol of ascent minimizing the risk associated with changes in altitude.
Topics: Adaptation, Physiological; Altitude; Altitude Sickness; Biomarkers; Humans; Italy; Occupational Diseases; Occupational Exposure; Oxygen; Population Surveillance; Research Design; Risk Assessment; Risk Factors; Work Capacity Evaluation
PubMed: 27297200
DOI: 10.7416/ai.2016.2102 -
Critical Care (London, England) May 2024Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery.
METHODS
A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed.
RESULTS
Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort.
CONCLUSIONS
In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.
Topics: Humans; Noninvasive Ventilation; Respiratory Insufficiency; Network Meta-Analysis; Intensive Care Units; Postoperative Period; Length of Stay
PubMed: 38720332
DOI: 10.1186/s13054-024-04924-0 -
Sensors (Basel, Switzerland) Feb 2024Respiratory diseases represent a significant global burden, necessitating efficient diagnostic methods for timely intervention. Digital biomarkers based on audio,...
Respiratory diseases represent a significant global burden, necessitating efficient diagnostic methods for timely intervention. Digital biomarkers based on audio, acoustics, and sound from the upper and lower respiratory system, as well as the voice, have emerged as valuable indicators of respiratory functionality. Recent advancements in machine learning (ML) algorithms offer promising avenues for the identification and diagnosis of respiratory diseases through the analysis and processing of such audio-based biomarkers. An ever-increasing number of studies employ ML techniques to extract meaningful information from audio biomarkers. Beyond disease identification, these studies explore diverse aspects such as the recognition of cough sounds amidst environmental noise, the analysis of respiratory sounds to detect respiratory symptoms like wheezes and crackles, as well as the analysis of the voice/speech for the evaluation of human voice abnormalities. To provide a more in-depth analysis, this review examines 75 relevant audio analysis studies across three distinct areas of concern based on respiratory diseases' symptoms: (a) cough detection, (b) lower respiratory symptoms identification, and (c) diagnostics from the voice and speech. Furthermore, publicly available datasets commonly utilized in this domain are presented. It is observed that research trends are influenced by the pandemic, with a surge in studies on COVID-19 diagnosis, mobile data acquisition, and remote diagnosis systems.
Topics: Humans; COVID-19 Testing; Artificial Intelligence; Respiratory Sounds; Respiratory Tract Diseases; Cough; Biomarkers
PubMed: 38400330
DOI: 10.3390/s24041173 -
Journal of Pain and Symptom Management Mar 2020Breathlessness is common in chronic conditions but often goes unidentified by clinicians. It is important to understand how identification and assessment of... (Review)
Review
CONTEXT
Breathlessness is common in chronic conditions but often goes unidentified by clinicians. It is important to understand how identification and assessment of breathlessness occurs across health care settings, to promote routine outcome assessment and access to treatment.
OBJECTIVE
The objective of this study was to summarize how breathlessness is identified and assessed in adults with chronic conditions across different health care settings.
METHODS
This is a systematic review and descriptive narrative synthesis (PROSPERO registration: CRD42018089782). Searches were conducted on Medline, PsycINFO, Cochrane Library, Embase, and CINAHL (2000-2018) and reference lists. Screening was conducted by two independent reviewers, with access to a third, against inclusion criteria. Data were extracted using a bespoke proforma.
RESULTS
Ninety-seven studies were included, conducted in primary care (n = 9), secondary care (n = 53), and specialist palliative care (n = 35). Twenty-five measures of identification and 41 measures of assessment of breathlessness were used. Primary and secondary care used a range of measures to assess breathlessness severity, cause, and impact for people with chronic obstructive pulmonary disease. Specialist palliative care used measures assessing broader symptom severity and function with less focus on overall quality of life. Few studies were identified from primary care.
CONCLUSION
Various measures were identified, reflective of the setting's purpose. However, this highlights missed opportunities for breathlessness management across settings; primary care is particularly well placed to diagnose and support breathlessness. The chronic obstructive pulmonary disease approach (where symptoms and quality of life are part of disease management) could apply to other conditions. Better documentation of holistic patient-reported measures may drive service improvement in specialist palliative care.
Topics: Adult; Chronic Disease; Dyspnea; Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life
PubMed: 31655187
DOI: 10.1016/j.jpainsymman.2019.10.014 -
NPJ Primary Care Respiratory Medicine Oct 2022Sleep-disordered breathing (SDB) is characterized by repeated breathing pauses during sleep. The prevalence of SDB varies widely between studies. Some longitudinal... (Review)
Review
Sleep-disordered breathing (SDB) is characterized by repeated breathing pauses during sleep. The prevalence of SDB varies widely between studies. Some longitudinal studies have found an association of SDB with incident or recurrent cardiovascular events. We sought to systematically describe the current data on the correlation between SDB and cardiovascular pathology. Studies were included if they were original observational population-based studies in adults with clearly diagnosed SDB. The primary outcomes include all types of cardiovascular pathology. We carried out pooled analyses using a random effects model. Our systematic review was performed according to the PRISMA and MOOSE guidelines for systematic reviews and was registered with PROSPERO. In total, 2652 articles were detected in the databases, of which 76 articles were chosen for full-text review. Fourteen studies were focused on samples of an unselected population, and 8 studies were focused on a group of persons at risk for SDB. In 5 studies, the incidence of cardiovascular pathology in the population with SDB was examined. In total, 49 studies described SDB in patients with cardiovascular pathology. We found an association between SDB and prevalent /incident cardiovascular disease (pooled OR 1.76; 95% CI 1.38-2.26), and pooled HR (95% CI 1.78; 95% CI 1.34-2.45). Notably, in patients with existing SDB, the risk of new adverse cardiovascular events was high. However, the relationship between cardiovascular disease and SDB is likely to be bidirectional. Thus, more large-scale studies are needed to better understand this association and to decide whether screening for possible SDB in cardiovascular patients is reasonable and clinically significant.
Topics: Cardiovascular Diseases; Humans; Incidence; Prevalence; Sleep Apnea Syndromes
PubMed: 36253378
DOI: 10.1038/s41533-022-00307-6 -
Intensive Care Medicine Apr 2021Most randomized controlled trials (RCTs) in patients with acute respiratory distress syndrome (ARDS) revealed indeterminate or conflicting study results. We aimed to...
PURPOSE
Most randomized controlled trials (RCTs) in patients with acute respiratory distress syndrome (ARDS) revealed indeterminate or conflicting study results. We aimed to systematically evaluate between-trial heterogeneity in reporting standards and trial outcome.
METHODS
A systematic review of RCTs published between 2000 and 2019 was performed including adult ARDS patients receiving lung-protective ventilation. A random-effects meta-regression model was applied to quantify heterogeneity (non-random variability) and to evaluate trial and patient characteristics as sources of heterogeneity.
RESULTS
In total, 67 RCTs were included. The 28-day control-group mortality rate ranged from 10 to 67% with large non-random heterogeneity (I = 88%, p < 0.0001). Reported baseline patient characteristics explained some of the outcome heterogeneity, but only six trials (9%) reported all four independently predictive variables (mean age, mean lung injury score, mean plateau pressure and mean arterial pH). The 28-day control group mortality adjusted for patient characteristics (i.e. the residual heterogeneity) ranged from 18 to 45%. Trials with significant benefit in the primary outcome reported a higher control group mortality than trials with an indeterminate outcome or harm (mean 28-day control group mortality: 44% vs. 28%; p = 0.001).
CONCLUSION
Among ARDS RCTs in the lung-protective ventilation era, there was large variability in the description of baseline characteristics and significant unexplainable heterogeneity in 28-day control group mortality. These findings signify problems with the generalizability of ARDS research and underline the urgent need for standardized reporting of trial and baseline characteristics.
Topics: Adult; Humans; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 33713156
DOI: 10.1007/s00134-021-06370-w -
Archives of Disease in Childhood Mar 2024Outdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the...
BACKGROUND
Outdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the association between short-term exposure to air pollution and respiratory morbidity in children in primary care.
OBJECTIVE
To evaluate whether children in a primary care setting exposed to outdoor air pollutants during short-term intervals are at increased risk of respiratory diagnoses.
METHODS
A search in Medline, the Cochrane Library, Web of Science and Embase databases throughout March 2023. Percentage change or risk ratios with corresponding 95% CI for the association between air pollutants and respiratory diseases were retrieved from individual studies. Risk of bias assessment was conducted with the Newcastle-Ottawa Scale (NOS) for cohort or case-control studies and an adjusted NOS for time series studies.
RESULTS
From 1366 studies, 14 were identified as meeting the inclusion criteria. Most studies had intermediate or high quality. A meta-analysis was not conducted due to heterogeneity in exposure and health outcome. Overall, studies on short-term exposure to air pollutants (carbon monoxide (CO), sulfur dioxide (SO), nitrogen dioxide (NO) and particulate matter ≤10 µm (PM)) were associated with increased childhood respiratory consultations in primary care. In general, exposure to ozone was associated with a reduction in respiratory consultations.
CONCLUSIONS
The evidence suggests CO, SO, NO, PM and PM are risk factors for respiratory diseases in children in primary care in the short term. However, given the heterogeneity of the studies, interpretation of these findings must be done with caution.
PROSPERO REGISTRATION NUMBER
CRD42022259279.
Topics: Adult; Child; Humans; Nitrogen Dioxide; Environmental Exposure; Air Pollution; Air Pollutants; Respiratory Tract Diseases; Disease Progression; Primary Health Care
PubMed: 38272647
DOI: 10.1136/archdischild-2023-326368 -
Critical Care (London, England) Apr 2024The relationship between smoking and the risk of acute respiratory distress syndrome (ARDS) has been recognized, but the conclusions have been inconsistent. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The relationship between smoking and the risk of acute respiratory distress syndrome (ARDS) has been recognized, but the conclusions have been inconsistent. This systematic review and meta-analysis investigated the association between smoking and ARDS risk in adults.
METHODS
The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for eligible studies published from January 1, 2000, to December 31, 2023. We enrolled adult patients exhibiting clinical risk factors for ARDS and smoking condition. Outcomes were quantified using odds ratios (ORs) for binary variables and mean differences (MDs) for continuous variables, with a standard 95% confidence interval (CI).
RESULTS
A total of 26 observational studies involving 36,995 patients were included. The meta-analysis revealed a significant association between smoking and an increased risk of ARDS (OR 1.67; 95% CI 1.33-2.08; P < 0.001). Further analysis revealed that the associations between patient-reported smoking history and ARDS occurrence were generally similar to the results of all the studies (OR 1.78; 95% CI 1.38-2.28; P < 0.001). In contrast, patients identified through the detection of tobacco metabolites (cotinine, a metabolite of nicotine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of tobacco products) showed no significant difference in ARDS risk (OR 1.19; 95% CI 0.69-2.05; P = 0.53). The smoking group was younger than the control group (MD - 7.15; 95% CI - 11.58 to - 2.72; P = 0.002). Subgroup analysis revealed that smoking notably elevated the incidence of ARDS with extrapulmonary etiologies (OR 1.85; 95% CI 1.43-2.38; P < 0.001). Publication bias did not affect the integrity of our conclusions. Sensitivity analysis further reinforced the reliability of our aggregated outcomes.
CONCLUSIONS
There is a strong association between smoking and elevated ARDS risk. This emphasizes the need for thorough assessment of patients' smoking status, urging healthcare providers to vigilantly monitor individuals with a history of smoking, especially those with additional extrapulmonary risk factors for ARDS.
Topics: Adult; Humans; Reproducibility of Results; Smoking; Risk Factors; 1-Butanol; Respiratory Distress Syndrome
PubMed: 38616271
DOI: 10.1186/s13054-024-04902-6 -
Intensive Care Medicine May 2024Assessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients... (Meta-Analysis)
Meta-Analysis
PURPOSE
Assessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients to enhance respiratory system mechanics and prevent ventilator-induced lung injury (VILI), compared to traditional methods.
METHODS
We carried out a systematic review and meta-analysis, spanning literature from January 2012 to May 2023, sourced from Scopus, PubMed, MEDLINE (Ovid), Cochrane, and LILACS, evaluated EIT-guided PEEP strategies in ARDS versus conventional methods. Thirteen studies (3 randomized, 10 non-randomized) involving 623 ARDS patients were analyzed using random-effects models for primary outcomes (respiratory mechanics and mechanical power) and secondary outcomes (PaO/FiO ratio, mortality, stays in intensive care unit (ICU), ventilator-free days).
RESULTS
EIT-guided PEEP significantly improved lung compliance (n = 941 cases, mean difference (MD) = 4.33, 95% confidence interval (CI) [2.94, 5.71]), reduced mechanical power (n = 148, MD = - 1.99, 95% CI [- 3.51, - 0.47]), and lowered driving pressure (n = 903, MD = - 1.20, 95% CI [- 2.33, - 0.07]) compared to traditional methods. Sensitivity analysis showed consistent positive effect of EIT-guided PEEP on lung compliance in randomized clinical trials vs. non-randomized studies pooled (MD) = 2.43 (95% CI - 0.39 to 5.26), indicating a trend towards improvement. A reduction in mortality rate (259 patients, relative risk (RR) = 0.64, 95% CI [0.45, 0.91]) was associated with modest improvements in compliance and driving pressure in three studies.
CONCLUSIONS
EIT facilitates real-time, individualized PEEP adjustments, improving respiratory system mechanics. Integration of EIT as a guiding tool in mechanical ventilation holds potential benefits in preventing ventilator-induced lung injury. Larger-scale studies are essential to validate and optimize EIT's clinical utility in ARDS management.
Topics: Humans; Positive-Pressure Respiration; Respiratory Distress Syndrome; Electric Impedance; Tomography; Ventilator-Induced Lung Injury; Respiratory Mechanics
PubMed: 38512400
DOI: 10.1007/s00134-024-07362-2 -
Anaesthesiology Intensive Therapy 2017Noninvasive ventilation has been widely used in the management of acute respiratory failure in appropriate clinical settings. In addition to known benefit of alleviating... (Review)
Review
Noninvasive ventilation has been widely used in the management of acute respiratory failure in appropriate clinical settings. In addition to known benefit of alleviating the need for invasive mechanical ventilation, recent literature suggested its beneficial use in the process of endotracheal intubation. Search of the PubMed database and manual review of selected articles investigating the methods and outcomes of endotracheal intubation in difficult airway due to hypoxemic respiratory failure and the role of noninvasive ventilation in this process. Large randomized controlled studies focused on alternative approaches to endotracheal intubation in severe hypoxemic respiratory failure are largely missing but there are several retrospective cohort analysis and reports describing the novel technique describing the application of noninvasive ventilation during endotracheal intubation. Noninvasive ventilation can be used as an adjunct intervention that may maintain oxygenation and ventilation, prevent significant hemodynamic instability and provide a pneumatic stent to maintain upper airway patency, thus reducing the risks of intubation-related complications.
Topics: Acute Disease; Airway Obstruction; Humans; Hypoxia; Intubation, Intratracheal; Noninvasive Ventilation; Randomized Controlled Trials as Topic; Respiratory Insufficiency
PubMed: 28920633
DOI: 10.5603/AIT.a2017.0044