Breathing Parameters Research Articles

Prediabetes Is Associated with Increased Prevalence of Sleep-Disordered Breathing.

Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea–hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events.

The Feasibility of a Machine Learning Approach in Predicting Successful Ventilator Mode Shifting for Adult Patients in the Medical Intensive Care Unit.

Background and Objectives: Traditional assessment of the readiness for the weaning from the mechanical ventilator (MV) needs respiratory parameters in a spontaneous breath. Exempted from the MV disconnecting and manual measurements of weaning parameters, a prediction model based on parameters from MV and electronic medical records (EMRs) may help the assessment before spontaneous breath trials. The study aimed to develop prediction models using machine learning techniques with parameters from the ventilator and EMRs for predicting successful ventilator mode shifting in the medical intensive care unit. Materials and Methods: A retrospective analysis of 1483 adult patients with mechanical ventilators for acute respiratory failure in three medical intensive care units between April 2015 and October 2017 was conducted by machine learning techniques to establish the predicting models. The input candidate parameters included ventilator setting and measurements, patients’ demographics, arterial blood gas, laboratory results, and vital signs. Several classification algorithms were evaluated to fit the models, including Lasso Regression, Ridge Regression, Elastic Net, Random Forest, Extreme Gradient Boosting (XGBoost), Support Vector Machine, and Artificial Neural Network according to the area under the Receiver Operating Characteristic curves (AUROC). Results: Two models were built to predict the success shifting from full to partial support ventilation (WPMV model) or from partial support to the T-piece trial (sSBT model). In total, 3 MV and 13 nonpulmonary features were selected for the WPMV model with the XGBoost algorithm. The sSBT model was built with 8 MV and 4 nonpulmonary features with the Random Forest algorithm. The AUROC of the WPMV model and sSBT model were 0.76 and 0.79, respectively. Conclusions: The weaning predictions using machine learning and parameters from MV and EMRs have acceptable performance. Without manual measurements, a decision-making system would be feasible for the continuous prediction of mode shifting when the novel models process real-time data from MV and EMRs.

Helical Fiber Strain Sensors Based on Triboelectric Nanogenerators for Self-Powered Human Respiratory Monitoring.

Respiration is a major vital sign, which can be used for early illness diagnosis and physiological monitoring. Wearable respiratory sensors present an exciting opportunity to monitor human respiratory behaviors in a real-time, noninvasive, and comfortable way. Among them, fiber-shaped triboelectric nanogenerators (FS-TENGs) are attractive for their comfort and high degree of freedom. However, the single-electrode FS-TENGs cannot respond to their own tensile strains, and the coaxial double-electrode FS-TENGs show low sensitivity to strain due to structural limitations. Here, a type of helical fiber strain sensor (HFSS) is developed, which can respond to tiny tensile strains. In addition, a smart wearable real-time respiratory monitoring system is developed based on the HFSSs, which can measure some key breathing parameters for disease prevention and medical diagnosis. An intelligent alarm can automatically call a preset mobile phone for help in response to respiratory behavior changes. This work provides an effective helical structure for fabricating highly sensitive strain sensors based on FS-TENGs and develops wearable self-powered real-time respiratory monitoring systems.

ПРОГНОСТИЧЕСКАЯ РОЛЬ ПАРАМЕТРОВ ДЫХАНИЯ В РАЗВИТИИ АРИТМИЙ У ПАЦИЕНТОВ С СИНДРОМОМ ОБСТРУКТИВНОГО НОЧНОГО АПНОЭ И ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Abstract. Obstructive sleep apnea syndrome (OSAS) is increasingly being considered as a factor associated with the development of nocturnal arrhythmias, as well as an increased risk of sudden cardiac death. The prevalence of OSA reaches 5-7% in the adult population. The prognostic role of pathological breathing patterns has not been sufficiently investigated, and therefore further study of the pathogenesis of arrhythmias for the subsequent intensification of therapeutic measures is promising. Aim of the Research. To study the prognostic significance of individual breathing parameters in different sleep phases for the development of atrial fibrillation and ventricular arrhythmias in patients with obstructive sleep apnea syndrome (OSAS) and chronic heart failure (CHF) with preserved ejection fraction (EF). Materials and methods. 86 men with moderate and severe OSAS (with an apnea/hypopnea index (AHI) &gt;15 per hour) were examined. To diagnose OSAS, all patients underwent a polysomnographic study of night sleep. The severity of obstructive respiratory disorders during sleep was assessed by the apnea/hypopnea index for the total period of sleeping. Using polysomnography, we additionally investigated the following parameters of respiratory disturbances during the night sleep period: index of obstructive apnea/hypopnea selectively in REM sleep (AHIobsREM); index of respiratory distress syndrome for the entire period of sleep (IRDS); index of respiratory distress syndrome in the REM sleep phase (IRDS REM); average saturation per night; desaturation index for the total period of sleep; desaturation index in REM sleep. The observation period was 12 months, during which the presence of atrial fibrillation paroxysms lasting more than 30 s and the development of high-grade ventricular arrhythmias (III-V class according to Ryan) were assessed. Results. In the course of the study, a number of breathing parameters during the night time sleep (IAHobs, IAHobsREM, IRDS, IRDS REM) significantly correlated with the development of the studied cardiac arrhythmias. The most significant prognostic role has been stated for obstructive sleep apnea registered in the REM sleep phase. Conclusion. Breathing parameters during nighttime sleeping (IAHobs, IAHobs REM, IRDS, IRDS REM), which characterize the severity of OSAS are independent predictors of the development of paroxysmal atrial fibrillation and high-grade ventricular extrasystole in patients with OSAS and CHF with preserved EF. The results obtained make it possible to use these sleep parameters in the future in stratifying the risk of arrhythmias and determining treatment tactics in this cohort of patients.

Nitrosyl factors play a vital role in the ventilatory depressant effects of fentanyl in unanesthetized rats

There is an urgent need to understand the intracellular mechanisms by which synthetic opioids, such as fentanyl, depress breathing. We used L-NAME (NG-nitro-L-arginine methyl ester), a nitric oxide synthase (NOS) inhibitor, to provide evidence for a role of nitric oxide (NO) and nitrosyl factors, including S-nitrosothiols, in fentanyl-induced suppression of breathing in rats. We measured breathing parameters using unrestrained plethysmography to record the changes produced by bolus administration of fentanyl (25 μg/kg, IV) in male Sprague Dawley rats that were pretreated with vehicle (saline), L-NAME (50 μmol/kg, IV) or the inactive D-isomer, D-NAME (50 μmol/kg, IV), 15 min previously. L-NAME produced a series of ventilatory changes that included (i) sustained elevations in breathing frequency, due to the reductions in the durations of inspiration and expiration, (ii) sustained elevations in minute ventilation, accompanied by minimal changes in tidal volume, and (iii) increases in inspiratory drive and expiratory drive, and peak inspiratory flow and peak expiratory flow. Subsequent administration of fentanyl in rats pretreated with vehicle produced negative effects on breathing, including decreases in frequency, tidal volume and therefore minute ventilation. Fentanyl elicited markedly different responses in rats that were pretreated with L-NAME, and conclusively, the negative effects of fentanyl were augmented by the NOS inhibitor. D-NAME did not alter ventilatory parameters or modulate the effects of fentanyl on breathing. Our study fully characterized the effects of L-NAME on ventilation in rats and is the first to suggest a potential role of nitrosyl factors in the ventilatory responses to fentanyl. Our data shows that nitrosyl factors reduce the expression of fentanyl-induced changes in ventilation.

Barium titanate piezoelectric-film-based beam-array airflow sensor for wearable breath-monitoring application

This study presents a barium titanate (BaTiO3) film-based piezoelectric airflow sensor. This sensor integrated a piezoelectric beam array with a poly(dimethylsiloxane) orifice membrane as the core sensing component. The compact size of the micromachined device fit the requirements for a wearable device. The hydrothermally grown barium titanate film exhibited an orthorhombic crystal structure with good piezoelectric properties. We propose an algorithm to determine the airflow sensor performance using data from the measured piezoelectric signal and the displacement of the piezoelectric beam. This algorithm correlates the discharge coefficient of the core sensing component, Reynold’s number, airflow velocity, pressure difference across the component, displacement of the piezoelectric beam, strain of the barium titanate film, and generated charge from the sensor, which is rarely reported in the literature. The Young’s modulus and piezoelectric constant of the barium titanate film could also be derived as 100 GPa and 8 pC N−1, respectively. Utilizing this algorithm and the generated piezoelectric signal of the sensor, important breath parameters of a young male subject at rest were monitored.

Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth.

Background: Preterm infants are commonly supported with 5–8 cmH2O CPAP. However, animal studies demonstrate that high initial CPAP levels (12–15 cmH2O) which are then reduced (termed physiological based (PB)-CPAP), improve lung aeration without adversely affecting cardiovascular function. We investigated the feasibility of PB-CPAP and the effect in preterm infants at birth.Methods: Preterm infants (24–30 weeks gestation) were randomized to PB-CPAP or 5–8 cmH2O CPAP for the first 10 min after birth. PB-CPAP consisted of 15 cmH2O CPAP that was decreased when infants were stabilized (heart rate ≥100 bpm, SpO2 ≥85%, FiO2 ≤ 0.4, spontaneous breathing) to 8 cmH2O with steps of ~2/3 cmH2O/min. Primary outcomes were feasibility and SpO2 in the first 5 min after birth. Secondary outcomes included physiological and breathing parameters and short-term neonatal outcomes. Planned enrollment was 42 infants.Results: The trial was stopped after enrolling 31 infants due to a low inclusion rate and recent changes in the local resuscitation guideline that conflict with the study protocol. Measurements were available for analysis in 28 infants (PB-CPAP n = 8, 5–8 cmH2O n = 20). Protocol deviations in the PB-CPAP group included one infant receiving 3 inflations with 15 cmH2O PEEP and two infants in which CPAP levels were decreased faster than described in the study protocol. In the 5–8 cmH2O CPAP group, three infants received 4, 10, and 12 cmH2O CPAP. During evaluations, caregivers indicated that the current PB-CPAP protocol was difficult to execute. The SpO2 in the first 5 min after birth was not different [61 (49–70) vs. 64 (47–74), p = 0.973]. However, infants receiving PB-CPAP achieved higher heart rates [121 (111–130) vs. 97 (82–119) bpm, p = 0.016] and duration of mask ventilation was shorter [0:42 (0:34–2:22) vs. 2:58 (1:36–6:03) min, p = 0.020]. Infants in the PB-CPAP group required 6:36 (5:49-11:03) min to stabilize, compared to 9:57 (6:58–15:06) min in the 5–8 cmH2O CPAP group (p = 0.256). There were no differences in short-term outcomes.Conclusion: Stabilization of preterm infants with PB-CPAP is feasible but tailoring CPAP appeared challenging. PB-CPAP did not lead to higher SpO2 but increased heart rate and shortened the duration of mask ventilation, which may reflect faster lung aeration.

How should we model and evaluate breathing interplay effects in IMPT?

Breathing interplay effects in Intensity Modulated Proton Therapy (IMPT) arise from the interaction between target motion and the scanning beam. Assessing the detrimental effect of interplay and the clinical robustness of several mitigation techniques requires statistical evaluation procedures that take into account the variability of breathing during dose delivery. In this study, we present such a statistical method to model intra-fraction respiratory motion based on breathing signals and assess clinical relevant aspects related to the practical evaluation of interplay in IMPT such as how to model irregular breathing, how small breathing changes affect the final dose distribution, and what is the statistical power (number of different scenarios) required for trustworthy quantification of interplay effects. First, two data-driven methodologies to generate artificial patient-specific breathing signals are compared: a simple sinusoidal model, and a precise probabilistic deep learning model generating very realistic samples of patient breathing. Second, we investigate the highly fluctuating relationship between interplay doses and breathing parameters, showing that small changes in breathing period result in large local variations in the dose. Our results indicate that using a limited number of samples to calculate interplay statistics introduces a bigger error than using simple sinusoidal models based on patient parameters or disregarding breathing hysteresis during the evaluation. We illustrate the power of the presented statistical method by analyzing interplay robustness of 4DCT and Internal Target Volume (ITV) treatment plans for a 8 lung cancer patients, showing that, unlike 4DCT plans, even 33 fraction ITV plans systematically fail to fulfill robustness requirements.

A comprehensive breath test that confirms recent use of inhaled cannabis within the impairment window

Legalization of cannabis for medicinal and/or recreational use is expanding globally. Although cannabis is being regulated country by country, an accurate recent use test with indisputable results correlated with impairment has yet to be discovered. In the present study, a new approach for determining recent cannabis use within the impairment window after smoking was developed by studying 74 subjects with a mean age of 25 years and average use history of 9 years. Horizontal gaze nystagmus was evaluated along with subject self-assessments of impairment, and blood and breath samples were collected before and after smoking cannabis. Breath and blood pharmacokinetic parameters and cannabinoid profiles determined recent use within the impairment window. No subjects were positive for recent use pre-smoking, although all subjects had detectable cannabinoids in breath samples. We describe an inhaled cannabis recent use test that correlates with impairment and helps protect against wrongful prosecution and workplace discrimination.

Inferring COPD Severity from Tidal Breathing.

To develop an algorithm that can infer the severity level of a COPD patient's airflow limitation from tidal breathing data that is collected by a wearable device. Data was collected from 25 single visit adult volunteers with a confirmed or suspected diagnosis of chronic obstructive pulmonary disease (COPD). The ground truth airflow limitation severity of each subject was determined by applying the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging criteria to the subject's spirometry results. Spirometry was performed in a pulmonary function test laboratory under the supervision of trained clinical staff. Separately, the subjects' respiratory signal was measured during quiet breathing, and a classification model was built to infer the subjects' level of airflow limitation from the measured respiratory signal. The classification model was evaluated against the ground truth using leave-one-out testing. Severity of airway obstruction was classified as either mild/moderate or severe/very severe with an accuracy of 96.4%. Tidal breathing parameters that are measured with a wearable device can be used to distinguish between different levels of airflow limitation in COPD patients.

Physiological responses and perceived comfort to high-flow nasal cannula therapy in awake adults: effects of flow magnitude and temperature.

Clinical use of heated, high-flow nasal cannula (HFNC) for noninvasive respiratory support is increasing and may have a therapeutic role in stabilizing the upper airway in obstructive sleep apnea (OSA). However, physiological mechanisms by which HFNC therapy may improve upper airway function and effects of different temperature modes are unclear. Accordingly, this study aimed to determine effects of incremental flows and temperature modes (heated and nonheated) of HFNC on upper airway muscle activity (genioglossus), pharyngeal airway pressure, breathing parameters, and perceived comfort. Six participants (2 females, aged 35 ± 14 yr) were studied during wakefulness in the supine position and received HFNC at variable flows (0-60 L/min) during heated (37°C) and nonheated (21°C) modes. Breathing parameters via calibrated Respitrace inductance bands (chest and abdomen), upper airway pressures via airway transducers, and genioglossus muscle activity via intramuscular bipolar fine wire electrodes were measured. Comfort levels during HFNC were quantified using a visual analog scale. Increasing HFNC flows did not increase genioglossus muscle activation despite increased negative epiglottic pressure swings (P = 0.009). HFNC provided ∼7 cmH2O positive airway pressure at 60 L/min in nonheated and heated modes. In addition, increasing the magnitude of HFNC flow reduced breathing frequency (P = 0.045), increased expiratory time (P = 0.040), increased peak inspiratory flow (P = 0.002), and increased discomfort (P = 0.004). Greater discomfort occurred at higher flows in the nonheated versus the heated mode (P = 0.034). These findings provide novel insight into key physiological changes that occur with HFNC for respiratory support and indicate that the primary mechanism for improved upper airway stability is positive airway pressure, not increased pharyngeal muscle activity.NEW & NOTEWORTHY This study evaluated upper airway muscle function, breathing, and comfort across different HFNC flows and temperatures. There were no increases in genioglossus muscle activity at higher flows despite greater negative epiglottic pressure swings. Increasing negative pressure swings was associated with increasing discomfort in the nonheated mode. HFNC was associated with ∼7 cmH2O increase in positive airway pressure, which may be the primary mechanism for upper airway stability with HFNC rather than increases in pharyngeal muscle activity.

Development of a tracking error prediction system for the CyberKnife Synchrony Respiratory Tracking System with use of support vector regression.

The accuracy of the CyberKnife Synchrony Respiratory Tracking System is dependent on the breathing pattern of a patient. Therefore, the tracking error in each patient must be determined. Support vector regression (SVR) can be used to easily identify the tracking error in each patient. This study aimed to develop a system with SVR that can predict tracking error according to a patient's respiratory waveform. Datasets of the respiratory waveforms of 93 patients were obtained. The feature variables were variation in respiration amplitude, tumor velocity, and phase shift between tumor and the chest wall, and the target variable was tracking error. A learning model was evaluated with tenfold cross-validation. We documented the difference between the predicted and actual tracking errors and assessed the correlation coefficient and coefficient of determination. The average difference and maximum difference between the actual and predicted tracking errors were 0.57 ± 0.63 mm and 2.1 mm, respectively. The correlation coefficient and coefficient of determination were 0.86 and 0.74, respectively. We developed a system for obtaining tracking error by using SVR. The accuracy of such a system is clinically useful. Moreover, the system can easily evaluate tracking error. We developed a system that can be used to predict the tracking error of SRTS in the CyberKnife Robotic Radiosurgery System using machine learning. The feature variables were the breathing parameters, and the target variable was the tracking error. We used support vector regression algorithm.

Measurement of breathing in patients with post-COVID-19 using structured light plethysmography (SLP)

IntroductionCOVID-19 pandemic has had a huge impact on global health to date, with 5.6 million cases in the UK since its emergence. The respiratory symptoms largely mimic those of pneumonia’...

An Overview of Wearable Piezoresistive and Inertial Sensors for Respiration Rate Monitoring

The demand for wearable devices to measure respiratory activity is constantly growing, finding applications in a wide range of scenarios (e.g., clinical environments and workplaces, outdoors for monitoring sports activities, etc.). Particularly, the respiration rate (RR) is a vital parameter since it indicates serious illness (e.g., pneumonia, emphysema, pulmonary embolism, etc.). Therefore, several solutions have been presented in the scientific literature and on the market to make RR monitoring simple, accurate, reliable and noninvasive. Among the different transduction methods, the piezoresistive and inertial ones satisfactorily meet the requirements for smart wearable devices since unobtrusive, lightweight and easy to integrate. Hence, this review paper focuses on innovative wearable devices, detection strategies and algorithms that exploit piezoresistive or inertial sensors to monitor the breathing parameters. At first, this paper presents a comprehensive overview of innovative piezoresistive wearable devices for measuring user’s respiratory variables. Later, a survey of novel piezoresistive textiles to develop wearable devices for detecting breathing movements is reported. Afterwards, the state-of-art about wearable devices to monitor the respiratory parameters, based on inertial sensors (i.e., accelerometers and gyroscopes), is presented for detecting dysfunctions or pathologies in a non-invasive and accurate way. In this field, several processing tools are employed to extract the respiratory parameters from inertial data; therefore, an overview of algorithms and methods to determine the respiratory rate from acceleration data is provided. Finally, comparative analysis for all the covered topics are reported, providing useful insights to develop the next generation of wearable sensors for monitoring respiratory parameters.

Aerosol delivery of inhalation devices with different add-on connections to invasively ventilated COPD subjects: An in-vivo study

Aerosol delivery to mechanically ventilated patients requires add-on connections to place the inhalation device within the ventilation circuit. The study aimed to evaluate the performance of Combihaler in dual limb invasive mechanical ventilation (IMV).A ventilator with a humidified dual limb circuit was adjusted to volume-controlled mode to imitate the adult breathing parameters. 24 (12 females) intubated chronic obstructive pulmonary disease (COPD) subjects had undergone the study. All patients were prescribed inhaled salbutamol dose delivered by either a metered-dose inhaler (pMDI) or vibrating mesh nebulizer (VMN). Each subject received salbutamol in four different inhalation device/connection conditions; pMDI+VMN+Combihaler, VMN+Combihaler, VMN+T-piece, and pMDI+T-piece. They were individually placed in the inspiratory limb at Y-piece. 5mg salbutamol was delivered by VMN with and without 2 pMDI puffs of salbutamol (100 µg), and 500µg was delivered by pMDI+T-piece. After aerosol delivery, two urine samples were collected from the patient; 30 min post-inhalation (USAL0.5) and cumulatively 24 h post-inhalation (USAL24) as indexes of lung deposition and systemic absorption, respectively. For the ex-vivo study, a collecting filter was placed before an endotracheal tube (ETT) to collect the delivered inhalable dose. In-vitro aerodynamic characteristics were also investigated.pMDI+VMN+Combihaler delivered more salbutamol to the lung and the ex-vivo filter than VMN+T-piece (p˂0.05, p≤0.01, respectively). VMN delivered a higher salbutamol amount to the lung, systemically, and the ex-vivo filter than pMDI+T-piece (p˂0.001). pMDI+VMN+Combihaler and VMN+Combihaler delivered aerosols with a less mass median aerodynamic diameter (MMAD) and higher fine particle fraction (FPF) compared to VMN+T-piece (p≤0.01 for MMAD, p˂0.01 for FPF) and pMDI+T-piece (p˂0.01 for both MMAD and FPF).Results of the study showed that pMDI+VMN+ Combihaler delivered more salbutamol than VMN+T-piece in IMV and demonstrate that 5 puffs (500-µg) of salbutamol with pMDI+T-piece has a lower aerosol delivering power at the level of USAL0.5, USAL24, and the ex-vivo inhalable dose than 5 mg nebulized salbutamol by VMNs in IMV.

Therapy of rhinosinusitis in childhood

Introduction. The relevance of the problem of rhinosinusitis in different ages is due to their high prevalence. The article presents information with approaches of the treatment rhinosinusitis in children, which allow preventing irreversible changes in the mucous membrane of the nasal cavity and paranasal sinuses. The importance of eliminating dysregulation in biological networks underlying the disease is noted. Such capabilities are possessed by means of bioregulatory medicine.Aim of the study: To carry out a comparative analysis of the effectiveness of chronic rhinosinusitis treatment with Euphorbium compositum and conventional methods of therapy in children.Materials and methods: We conducted retro- and prospective study in children’s polyclinic No. 1 and homeopathic center “Homeopathic medicine” in Samara. There were 66 children aged 7 to 12 years old diagnosed with chronic rhinosinusitis under observation. The children were observed in two groups for 2 years. Results. In chronic sinusitis within 2 weeks after the beginning of the course of therapy significant symptomatic improvement was registered in 75.8% of the patients receiving Euforbium compositum and in 71.3% of the patients receiving conventional medical therapy. During the clinical observations there was not a single case of adverse effects against the background of Euphorbium compositum therapy, the patients’ general condition and nasal breathing parameters reliably improved.Results.Numerous scientific studies noted: the ability of nasal spray Euphorbium compositum to have a complex multi-target effect on the process of inflammation, on the state of nasal mucous membranes; safety and effectiveness.Conclusions. Complex bioregulating action of Euphorbium compositum Nasentropfen C allows to control and optimize the course of chronic inflammatory process in rhinosinusitis. Its application promotes restoration of structure and function of nasal cavity mucosa, it is not accompanied by complications. These characteristics in combination with good tolerability make it possible to use the drug for treatment of rhinosinusitis.

Quantifying Delivered Dose with Jet and Mesh Nebulizers during Spontaneous Breathing, Noninvasive Ventilation, and Mechanical Ventilation in a Simulated Pediatric Lung Model with Exhaled Humidity.

Acutely ill children may transition between spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV), and commonly receive the same drug dosage with each type of ventilatory support and interface. This study aims to determine the aerosol deposition with jet (JN) and mesh nebulizers (MN) during SB, NIV, and MV using a pediatric lung model. Drug delivery with JN (Mistymax10) and MN (Aerogen Solo) was compared during SB, NIV, and MV using three different lung models set to simulate the same breathing parameters (Vt 250 mL, RR 20 bpm, I:E ratio 1:3). A heated humidifier was placed between the filter and test lung to simulate exhaled humidity (35 ± 2 °C, 100% RH) with all lung models. Albuterol sulfate (2.5 mg/3 mL) was delivered, and the drug deposited on an absolute filter was eluted and analyzed with spectrophotometry. Aerosol delivery with JN was not significantly different during MV, NIV, and SB (p = 0.075), while inhaled dose obtained with MN during MV was greater than NIV and SB (p = 0.001). The delivery efficiency of MN was up to 3-fold more than JN during MV (p = 0.008), NIV (p = 0.005), and SB (p = 0.009). Delivered dose with JN was similar during MV, NIV, and SB, although the delivery efficiency of MN differs with different modes of ventilation.

The VICTORY (Investigation of Inflammacheck to Measure Exhaled Breath Condensate Hydrogen Peroxide in Respiratory Conditions) Study: Protocol for a Cross-sectional Observational Study.

BackgroundMore than 7% of the world’s population is living with a chronic respiratory condition. In the United Kingdom, lung disease affects approximately 1 in 5 people, resulting in over 700,000 hospital admissions each year. People with respiratory conditions have several symptoms and can require multiple health care visits and investigations before a diagnosis is made. The tests available can be difficult to perform, especially if a person is symptomatic, leading to poor quality results. A new, easy-to-perform, point-of-care test that can be performed in any health care setting and that can differentiate between various respiratory conditions would have a significant, beneficial impact on the ability to diagnose respiratory diseases.ObjectiveThe objective of this study is to use a new handheld device (Inflammacheck) in different respiratory conditions to measure the exhaled breath condensate hydrogen peroxide (EBC H2O2) and compare these results with those of healthy controls and with each other. This study also aims to determine whether the device can measure other parameters, including breath humidity, breath temperature, breath flow dynamics, and end tidal carbon dioxide.MethodsWe will perform a single-visit, cross-sectional observational study of EBC H2O2 levels, as measured by Inflammacheck, in people with respiratory disease and volunteers with no known lung disease. Participants with a confirmed diagnosis of asthma, chronic obstructive pulmonary disease, lung cancer, bronchiectasis, pneumonia, breathing pattern disorder, and interstitial lung disease as well as volunteers with no history of lung disease will be asked to breathe into the Inflammacheck device to record their breath sample.ResultsThe results from this study will be available in 2022, in anticipation of COVID-19–related delays.ConclusionsThis study will investigate the EBC H2O2, as well as other exhaled breath parameters, for use as a future diagnostic tool.

A novel sulfur mustard (HD) vapor inhalation exposure model of pulmonary toxicity for the efficacy evaluation of candidate medical countermeasures

Objective To develop a novel inhalation exposure system capable of delivering a controlled inhaled HD dose through an endotracheal tube to anesthetized rats to investigate the lung pathophysiology and evaluate potential medical countermeasures. Materials and methods Target HD vapor exposures were generated by a temperature-controlled vapor generator, while concentration was monitored near real-time by gas chromatography. Animal breathing parameters were monitored real-time by in-line EMKA/SciReq pulmonary analysis system. Individual exposures were halted when the target inhaled doses were achieved. Animals were observed daily for clinical observations and lethality with scheduled termination at 28 days post-exposure. Upon scheduled or unscheduled death, animals underwent a gross necropsy and lung and trachea were collected for histopathology. Results Controlled HD concentrations ranged from 60 to 320 mg/m3. Delivered inhaled doses range from 0.3 to 3.20 mg/kg with administered doses within 3% of the target. The 28-day inhaled LD50 is 0.80 mg/kg (95% CI = 0.42–1.18 mg/kg). Post exposure respiratory abnormalities were observed across all dose levels though the higher dose levels had earlier onset and higher frequency of occurrence. Histopathologic alterations were not qualitatively altered in accordance with dose but instead showed a relationship to an animals’ time of death, with early deaths demonstrating acute damage and later deaths displaying signs of repair. Discussion/Conclusion This novel exposure system administers targeted HD inhaled doses to generate a small animal model that can be used to evaluate physiological toxicities of inhaled HD on the lungs and for evaluation of potential medical countermeasure treatments.

Sleep disturbances and related disordered breathing after hip replacement surgery: A randomised controlled trial

IntroductionMechanisms of postoperative sleep architecture disturbances and sleep-disordered breathing are uncertain. The authors hypothesised that patients undergoing surgery under regional anaesthesia without opioids used for postoperative analgesia would experience lesser changes in these parameters than patients operated under general anaesthesia with per- and postoperative opioids. Patients and methodsAfter ethical approval and informed consent, patients undergoing total hip replacement were included in a prospective, randomised trial comparing 3 groups of patients: (1) S-LPB group receiving spinal anaesthesia and postoperative analgesia by lumbar plexus block; (2) GA-PCA group receiving general anaesthesia and postoperative analgesia by morphine patient-controlled analgesia; (3) GA-LPB group receiving general anaesthesia and postoperative analgesia by lumbar plexus block. Outcome measurements were polysomnographic parameters of sleep architecture and sleep-disordered breathing. ResultsEighteen patients completed the 5-night study protocol (preoperative night: N-1, postoperative nights: N1 to N4). The percentage of rapid eye movement (REM) sleep decreased by 49% and 47% during N1 in the GA-PCA and GA-LPB groups respectively. A rebound phenomenon of more than 40% in the GA-PCA group and 25% in the GA-LPB group was observed during N2 and N3. Apnoea hypopnoea index (AHI) and the number of arousals per hour were significantly increased during N2 and N3 when compared with N-1 in the GA-groups. No sleep architecture disturbances and no sleep-disordered breathing were measured in the S-LPB group. ConclusionPostoperative sleep architecture and breathing pattern were disturbed in GA groups. Both were preserved under spinal anaesthesia associated with a free opioid postoperative analgesia.