Chronic Respiratory Insufficiency Research Articles (Page 1)

Diaphragm Interventions in Acute Flaccid Myelitis: A Single-Center Retrospective Case Series of Diaphragm Pacing Systems and Phrenic Nerve Transfers.

Long-term outcomes from home invasive mechanical ventilation (HIMV) in Queensland.

Roborovski dwarf hamsters are permissive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and progress to acute viral pneumonia with profound lung tissue injury, recapitulating hallmarks of severe coronavirus disease 2019 (COVID-19) in vulnerable patient groups such as older adults. In this study, we established dwarf hamster whole-body plethysmography and assessed disease severity and propensity for long-term compromise of lung recovery from severe COVID-19-like disease in young, adult, and aged animals. Aged dwarf hamsters infected intranasally with variant of concern (VOC) omicron BA.4 experienced more severe clinical signs, carried a higher lung virus load, and had a greater risk of succumbing to infection. Resting airway hypersensitivity was transiently increased in aged, but not young, dwarf hamsters 3-4 days post-infection. Pharmacologically induced respiratory distress revealed compromised lung capacity in animals of both age groups at peak disease. Aged animals showed impaired respiratory function for 45 days, mounted a weaker antiviral response, and developed chronic pneumonia with lasting tissue damage. Treatment of acute disease with approved antivirals, paxlovid-like nirmatrelvir + ritonavir or molnupiravir, prevented long-term respiratory sequelae in aged animals. Nirmatrelvir + ritonavir fully suppressed transient respiratory distress and mediated complete survival of aged animals. This study shows a high positive correlation between host age and SARS-CoV-2 disease severity in dwarf hamsters, establishes a model for chronic pneumonia with impaired respiratory capacity in at-risk hosts, and demonstrates the benefit of antiviral therapy of acute disease for long-term respiratory health.IMPORTANCEIn the COVID-19 pandemic, the frequency of chronic respiratory insufficiency after acute SARS-CoV-2 infection was positively linked to patient age. Roborovski dwarf hamsters recapitulate hallmarks of life-threatening COVID-19 in at-risk patients. In this study, we monitored disease progression and lung function in young and aged dwarf hamsters infected with a VOC omicron isolate and assessed the effect of antiviral treatment on long-term lung function. We established a strong correlation between host age and SARS-CoV-2 disease severity in dwarf hamsters, identified a high propensity of aged animals to develop chronic lung inflammation, and demonstrated a long-term loss of respiratory capacity in the subset of aged animals that survived the acute infection. Antiviral treatment suppressed the development of late sequelae and preserved lung function. These results have important implications for effective SARS-CoV-2 management in aged hosts at high risk of developing severe viral pneumonia with long-term impaired lung function.

Home mechanical ventilation (HMV) has evolved significantly over the past decade. While initially used primarily for neuromuscular diseases, the increasing application of non-invasive ventilation (NIV) for chronic obstructive pulmonary disease (COPD) has demonstrated significant benefits in reducing mortality and hospitalizations. Concurrently, the prevalence of obesity hypoventilation syndrome (OHS) is rising, necessitating adapted treatment strategies. The newly updated German S3-guideline differentiates between NIV and invasive ventilation and includes refined indication criteria, particularly for COPD. Furthermore, it incorporates ethical considerations regarding decision-making in ventilation therapy and end of life. Alternative treatment options for chronic respiratory insufficiency are also gaining clinical and scientific attention. High flow therapy, which is already being used effectively for acute respiratory insufficiency, is increasingly being used for chronic respiratory insufficiency. Furthermore, the implementation of the Intensive Care and Rehabilitation Strengthening Act (IPREG) has established new quality standards in long-term mechanical ventilation, yet challenges persist in its nationwide application.

Using normal pulse oximetry (SpO2) values as basis, an oxygen saturation <98% could reflect hypoxaemia in childhood. The objectives were to define the level of SpO2 associated with hypoxaemia, the prevalence of SpO2 <98% in children suffering from chronic diseases referred to pulmonary function testing units. Two university paediatric hospitals. We retrospectively selected arterialised blood gas (ABG) analyses and SpO2 recordings, and further recorded pulmonary function test (PFT) indices (z-scores of forced expiratory volume at 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and total lung capacity) of visits with SpO2<98% (Radical-7 pulse oximeter, Masimo). The Bland-Altman analysis of saturations (n=1188) showed that SpO2 overestimated arterialised saturation (bias: +1.3%, precision: ±1.1%). The 20 ABGs with SpO2≤95% showed hypoxaemia (z-score of arterialised pressure of O2<-1.96), while 48/74 (65%) ABGs with SpO2 of 96% or 97% showed hypoxaemia. Three thousand eight hundred twenty-four PFTs were recorded in 2641 children (1186 girls, 1455 boys) with a mean age (±SD) of 12.3±3.5 years. The prevalence of SpO2<98% was 114/2641 children (4.3%, 95% CI 3.6 to 5.2), showing that hypoxaemia was mainly observed in chronic obstructive diseases (96 children). Twelve children had SpO2≤95% and all had ventilatory defects (based on international definitions of PFT). An oxygen saturation ≤95%, using the Masimo oximeter, is indicative of hypoxaemia and PFT abnormalities, while oxygen saturation of 96% or 97% indicates possible hypoxaemia. Thus, chronic respiratory insufficiency can confidently be diagnosed if repeated SpO2 is ≤95% using the Masimo oximeter.

PurposeDiabetes, particularly type 2 diabetes (T2D), is a common comorbidity that occurs at a higher frequency in chronic obstructive pulmonary disease (COPD) patients compared to the general population. The COPD-diabetes association is documented epidemiologically and experimentally. Potential mechanisms, including systemic inflammation and metabolic dysregulation, are discussed as plausible pathways. However, their causal relationship still needs to be confirmed.MethodsWe conducted a comprehensive bidirectional two-sample Mendelian randomization (MR) analysis to evaluate the causal links between COPD and both type 1 diabetes (T1D) and T2D by using genome-wide association study (GWAS) summary statistics in European and Asian populations. By employing MR methods, the causal effect of diabetes on the risk of COPD as well as specific COPD-related clinical outcomes, including COPD with infections (COPD-I), pneumonia or pneumonia-derived septicaemia, chronic opportunistic infections, respiratory insufficiency, hospital admissions, and onset age (early or late) were explored.ResultsForward MR analysis provided evidence consistent with a causal relationship between T2D and an increased risk of COPD in the European population (IVW odds ratio (OR): 1.002, 95% confidence interval (CI): 1.001–1.003, P = 0.001). This association appeared consistent with MR Egger analysis, yielding a similar result for European COPD patients (MR Egger OR: 1.108, 95% CI: 1.016 −1.208, P = 0.021). No statistically conclusive evidence of a causal relationship between diabetes and COPD was found in the Asian population. Besides, genetically determined T1D was identified as a risk factor for the incidence of COPD-I in the European-specific population (IVW OR: 1.017, 95% CI: 1.009–1.025, P < 0.001). The reverse MR analysis, exploring the effect of COPD on the risk of diabetes, did not achieve consistent results in either the European or Asian populations.ConclusionThis study suggested a modest but statistically significant causal association between T2D and COPD in individuals of European ancestry. Further explorations are required to better understand the underlying mechanisms linking diabetes to COPD development.

The german guideline on non-invasive ventilation offers comprehensive recommendations for the treatment of chronic respiratory failure in various underlying conditions, such as COPD, thoraco-restrictive diseases, obesity-hypoventilation syndrome, and neuromuscular diseases. The aim of the guideline is to improve the treatment of patients with chronic respiratory insufficiency using non-invasive ventilation and to make the indications and therapy recommendations accessible to all involved in the treatment process. It is based on the latest scientific evidence and replaces the previous guideline from 2017. This revised guideline provides detailed recommendations on the application of non-invasive ventilation, ventilation settings, and the subsequent follow-up of treatment. In addition to the updated evidence, important new features of this guideline include new recommendations on patient care and numerous detailed treatment pathways that make the guideline more user-friendly. Furthermore, a completely revised section is dedicated to ethical issues and offers recommendations for end-of-life care. This guideline is an important tool for physicians and other healthcare professionals to optimize the care of patients with chronic respiratory failure.

Background. Spinal muscular atrophy 5q (SMA) is a severe genetic neuromuscular disorder, which is primarily manifested through musclar weakness. Previously, cognitive development in the natural course of SMA was considered normal. The introduction of etiopathogenetic therapy has altered the disease trajectory, led to new phenotypes, improved survival rates, and outlined the importance of studying the development of emotional, cognitive, and communicative domains, and adaptive behavior in SMA patients.Aim. To conduct a comprehensive assessment of emotional, cognitive, and adaptive domains, as well as speech development, in patients with genetically confirmed SMA, including cases, which were identified through newborn screening programs and were asymptomatic at the initiation of etiopathogenetic therapy, and to identify factors influencing neuropsychic development in SMA patients.Materials and methods. The study included 87 SMA patients receiving etiopathogenetic therapy, aged 0–12 years (median age at testing – 57.0 [37.0; 103.0] months). The Developmental Profile-3 (DP-3) instrument was used to assess neuropsychic development. Statistical analysis was performed using SPSS Statistics v.26.0 (IBM, USA).Results. Children who received therapy at the presymptomatic stage (6.9 % of the cohort) showed no deficits in any assessed developmental domains. These results significantly differed from those of SMA types 1, 2, and 3 in motor skills (padj &lt;0.001) and adaptive behavior (padj ≤0.026). Patients with SMA types 1, 2, and 3 exhibited severe motor impairments (reduced motor skills in 93.0 %, 89.7 %, and 88.9 % of children, respectively) and adaptive deficits (impairments in ≥55 % of each group). SMA type 1 patients additionally demonstrated delays in social emotional (39.5 %), cognitive (30.2 %), and communicative (39.5 %) domains. Children with lower functional status (“lying”) had more pronounced delays in adaptive, social emotional, and cognitive domains (p ≤0.048). In SMA type 1, fewer SMN2 gene copies and earlier disease onset correlated with more severe deficits in emotional, cognitive, and adaptive domains, as well as in speech development (SMN2 copies: p ≤0.034; age of onset: p ≤0.012). SMA type 1 patients with dysphagia showed lower scores across all subscales except motor skills (p ≤0.015). Chronic respiratory insufficiency was associated with reduced scores in all five subscales: in SMA type 1, motor skills, adaptive, social emotional, and cognitive domains were affected (p ≤0.045); in SMA type 2, adaptive, social emotional, and cognitive domains were affected (p ≤0.018). Delayed therapy initiation correlated with lower motor and adaptive scores in SMA types 1 (p ≤0.012), 2 (p ≤0.002), and 3 (p ≤0.048), and with worse social emotional and cognitive outcomes in SMA type 2 (p = 0.001).Conclusion. SMA patients exhibit not only motor impairments but also adaptive and socialization deficits, as well as delays in communicative and cognitive development. A standardized approach to identifying these impairments should be developed, and developing tailored rehabilitation methods is important as well. Initiating etiopathogenetic therapy at the presymptomatic stage may prevent neuropsychiatric manifestations of SMA.

Delphi Consensus on the Management of Patients With Advanced COPD: COPD-Avanz Working Group.

Abstract Home mechanical ventilation (HMV) has revolutionized pediatric care by enabling children with chronic respiratory insufficiency to transition from hospital to home settings, significantly enhancing their quality of life. This review examines the historical development, technological advancements, and current practices in pediatric HMV, emphasizing its impact on patients, caregivers, and healthcare systems. Initially developed in the 1970s to address respiratory failure in neuromuscular disorders, HMV has since evolved with innovations such as portable ventilators, enhanced safety features, and improved patient–ventilator synchronization. These advancements have facilitated its application across diverse conditions, including bronchopulmonary dysplasia, congenital central hypoventilation syndrome, and scoliosis, allowing many children to benefit from home-based care. While HMV offers numerous advantages, including reduced incidence of hospitalizations and the ability for children to engage in family and community life, it also presents challenges. Caregivers must navigate complex technical, financial, and emotional demands, often experiencing significant stress and anxiety. The lack of comprehensive home respiratory care infrastructure and inconsistent access to multidisciplinary support further complicates caregiving. Ethical considerations and financial feasibility also influence decisions to initiate HMV, highlighting the need for systemic support and policy enhancements. Despite these challenges, HMV has improved the survival and quality of life in ventilator-dependent children. Future efforts should focus on advancing device technology, fostering family-centered care models, and strengthening the collaboration among healthcare teams. Comprehensive training for caregivers and the integration of holistic support systems are critical to optimizing outcomes for pediatric patients and their families. This review underscores the transformative potential of HMV in pediatric care while advocating for continued innovation and systemic improvements to address unmet needs and ensure sustainable home-based respiratory care.

Abstract Tracheostomy is a common surgery in children, usually required due to chronic respiratory insufficiency or neuromuscular illnesses. While tracheostomy considerably improves respiratory control, it also increases the risk of serious consequences such as tube dislodgement and blockage. This article describes a catastrophic event in which a dislodged tracheostomy tube (TT) occurred in a 10-year-old female patient with cerebral palsy who had been on ventilator support for 5 years. The dislodged tube slipped unnoticed into the right main bronchus, causing severe respiratory distress and sudden reduction in oxygen saturation. This life-threatening condition requires rapid diagnosis and surgical management. It also reviews the relevant literature to provide insights into best practices for managing similar cases, highlighting the importance of early identification and management of rare complications to prevent life-threatening outcomes. Key takeaways from this TT fracture case report highlight the importance of vigilance in long-term patient care. Early intervention is critical for patient safety, and healthcare providers should be aware of fracture risk in patients with prolonged TT use. Regular monitoring and maintenance are essential to prevent complications. This report emphasizes the need to investigate cleaning and sterilization methods to determine their impact on TT structural integrity.

Background: Tuberculosis (TB) is a preventable and treatable disease. However, without treatment, mortality from TB is 50%, whereas with treatment, 85% of people with TB can be cured. Incomplete treatment of pulmonary TB can lead to various complications, one is hydropneumothorax, which is an abnormal picture of air and fluid in the pleural cavity. Complications of this condition can lead to long-term impairment of lung function with varying degrees of severity. Pain and shortness of breath are clinical features that interfere with daily activities and are associated with a decreased quality of life. Pulmonary rehabilitation is a crucial component in managing respiratory diseases, including pneumothorax, which aims to restore respiratory muscle strength, optimize lung expansion, and prevent complications such as atelectasis, pleural adhesions, or chronic respiratory insufficiency. Case: A 26-year-old woman presented to the emergency department with moderate dyspnea. She was diagnosed with loss to follow-up (LTFU) TB with bilateral hydropneumothorax and malnutrition. She was in the third month of a four-drug anti-TB regimen and had a chest tube with water shield drainage (WSD) placed in both the right and left chest walls. The rehabilitation problems in these patients are dyspnea, pain in the chest tube insertion area, immobilization, and partial dependency. Discussion: A pulmonary rehabilitation program was initiated during hospitalization and continued in the outpatient rehabilitation clinic, including energy conservation techniques, breathing exercises, relaxation, splinted cough, chest wall mobilization, respiratory muscle stretching, and laser therapy for pain management. Barthel Index (BI) shows improvement from 10 to 45 due to pain reduction. Visual Analog Scale (VAS) 7-8 to 5, allowing the patient to use her right upper extremity for daily activities. Conclusion: Pulmonary rehabilitation is a cost-effective therapy that can improve symptoms and quality of life in patients with post-TB hydropneumothorax. It also reduces spasms, dyspnea, and pain.

BackgroundReduced forced vital capacity (FVC) is associated with morbidity and mortality in individuals with Duchenne muscular dystrophy (DMD). Non-invasive ventilation (NIV) is often prescribed for the treatment of sleep-disordered breathing (SDB), and chronic respiratory insufficiency. Despite the common practice of initiating NIV later in the progression of DMD, the factors influencing FVC subsequent to the commencement of NIV remain unclear.ObjectiveTo evaluate the demographic, clinical and socioeconomic determinants of FVC% predicted across several cohorts of DMD children and adults prescribed NIV.MethodsA multicenter retrospective review of individuals with DMD prescribed NIV was performed between February 2016 to October 2020. Patients were identified from three sites: The Hospital for Sick Children, Canada; Rady Children’s Hospital San Diego, USA; and University of California San Diego Health, USA. Multivariate regression analysis was performed to determine factors that influence FVC.ResultsFifty-nine male patients with DMD prescribed NIV (mean ± SD for age and BMI was 20.1 ± 6.7 years and 23.8 ± 8.8 kg/m2) were included. Following multivariate analysis, a lower FVC% predicted was associated with older age (β = -1.44, p = 0.001), presence of scoliosis (β = -16.94, p = 0.002), absent deflazacort prescription (β = 14.43, p = 0.009), and use of in-ex sufflator (β = -39.73, p < 0.001), respectively.ConclusionIn our study, several factors were associated with reduced FVC% predicted in a DMD population using NIV. Future, prospective, longitudinal studies are imperative to comprehend the trajectory of FVC% predicted over time in individuals with DMD using NIV.

Studies have shown varying patient adherence to long-term non-invasive positive airway pressure therapy (nPAP). We aimed to investigate adherence to long-term nPAP in a Danish cohort of patients with chronic respiratory insufficiency and/or sleep-disordered breathing (SDB) due to neuromuscular disorders (NMD), obesity-hypoventilation syndrome (OHS) or other reasons. This cohort study included all adult patients with association to the Respiratory Center East treated with long-term nPAP: bilevel (BiPAP), automatic (APAP) and continuous (CPAP) or adaptive servo-ventilation (ASV) with a remote monitoring system in April 2022. The primary outcome was adherence, defined as a median use of nPAP ≥ 4 hrs/day in April 2022. A preplanned extended subgroup analysis was conducted for patients with data on adherence from initiation and six months onwards. The primary analysis included 241 patients, of whom 90% were diagnosed with NMD (54%) or OHS (36%). The nPAP was used ≥ 4 hrs/day by 175 patients (73%), including 22 (100%) with ASV, 129 (72%) with BiPAP and 24 (59%) with APAP/CPAP. Treatment adherence was seen in 75% of patients with NMD, 64% with OHS and 84% with other reasons for SDB. The proportion of adherent subjects in the subgroup analysis of 55 patients was relatively stable throughout the six-month period, ranging from 67% to 75% with slight intraindividual variation. In this retrospective analysis of adults primarily with NMD and OHS, 73% used the prescribed nPAP therapy ≥ 4 hrs/day. None TRIAL REGISTRATION. gov(NCT05379309).

The S3 guideline on non-invasive ventilation as a treatment for chronic respiratory failure was published on the website of the Association of the Scientific Medical Societies in Germany (AWMF) in July 2024. It offers comprehensive recommendations for the treatment of chronic respiratory failure in various underlying conditions, such as COPD, thoraco-restrictive diseases, obesity-hypoventilation syndrome, and neuromuscular diseases. An important innovation is the separation of the previous S2k guideline dating back to 2017, which included both invasive and non-invasive ventilation therapy. Due to increased scientific evidence and a significant rise in the number of affected patients, these distinct forms of therapy are now addressed separately in two different guidelines.The aim of the guideline is to improve the treatment of patients with chronic respiratory insufficiency using non-invasive ventilation and to make the indications and therapy recommendations accessible to all involved in the treatment process. It is based on the latest scientific evidence and replaces the previous guideline. This revised guideline provides detailed recommendations on the application of non-invasive ventilation, ventilation settings, and the subsequent follow-up of treatment.In addition to the updated evidence, important new features of this S3 guideline include new recommendations on patient care and numerous detailed treatment pathways that make the guideline more user-friendly. Furthermore, a completely revised section is dedicated to ethical issues and offers recommendations for end-of-life care. This guideline is an important tool for physicians and other healthcare professionals to optimize the care of patients with chronic respiratory failure. This version of the guideline is valid for three years, until July 2027.

BackgroundStudies on long-term invasive mechanical ventilation (IMV) via tracheostomy in chronic respiratory insufficiency are limited. The aim of this study was to clarify the use of HIMV (home invasive mechanical ventilation) within the Finnish population and to analyze the characteristics and survival rate of HIMV patients from 2015 to 2022.MethodsData on HIMV patients was collected annually from all Finnish Hospital District patient registries between January 1, 2015, and December 31, 2022. Data included basic demographic data of the patients, underlying diagnosis, time from diagnosis to HIMV initiation, treatment duration, and mortality.ResultsThis study included 179 patients. In 2015, there were 107 HIMV patients, and as of December 31, 2022, there were 95 patients. During the eight-year follow-up period, 84 patients (46.9%) died and there were 67 new patients between 2015 and2022. The prevalence of HIMV treatment in Finland was 2.4/100,000 on January 1,2015, and 1.8/ 100 000 on December 31, 2022. The average number of years living with HIMV for deceased patients at death was 10.1 ± 10.5 years largely depending on the underlying diagnosis. Of all the HIMV treatments, 32% were elective.ConclusionsHIMV is a rare treatment in Finland, and based on our 8-year follow-up, prevalence of HIMV is diminishing. Given the high demands, and significant costs associated with HIMV, it is essential to prepare for long treatment, when planning HIMV. It is also advisable to prolong non-invasive ventilation (NIV) treatments for as long as possible.

PurposeEvidence on the incidence and persistence of post-acute sequelae of COVID-19 (PASC) among children and adolescents is still limited.MethodsIn this retrospective cohort study, 59,339 children and adolescents with laboratory-confirmed COVID-19 in 2020 and 170,940 matched controls were followed until 2021-09-30 using German routine healthcare data. Incidence rate differences (ΔIR) and ratios (IRR) of 96 potential PASC were estimated using Poisson regression. Analyses were stratified according to age (0–11, 12–17 years), and sex. At the individual level, persistence of diagnoses in patients with onset symptoms was tracked starting from the first quarter post-infection.ResultsAt 0–3 month follow-up, children and adolescents with a previous SARS-CoV-2 infection showed a 34% increased risk of adverse health outcome, and approximately 6% suffered from PASC in association with COVID-19. The attributable risk was higher among adolescents (≥ 12 years) than among children. For most common symptoms, IRRs largely persisted at 9–12 month follow-up. IRR were highest for rare conditions strongly associated with COVID-19, particularly inflammatory conditions among children 0–11 years, and chronic fatigue and respiratory insufficiency among adolescents. Tracking of diagnoses at the individual level revealed similar rates in the decline of symptoms among COVID-19 and control cohorts, generally leaving less than 10% of the patients with persistent diagnoses after 12 months.ConclusionAlthough very few patients presented symptoms for longer than 12 months, excess morbidity among children and, particularly, adolescents with a history of COVID-19 means a relevant burden for pediatric care.

Long-term oxygen therapy (LTOT) is reported to improve survival in patients with chronic respiratory failure. We aimed to describe effectiveness, burden, and cost of illness of patients treated with portable oxygen concentrators (POC) compared to other LTOT options. This retrospective comparative analysis included adult patients with chronic respiratory insufficiency and failure (CRF) upon a first delivery of LTOT between 2014 and 2019 and followed until December 2020, based on theFrench national healthcare database SNDS. Patients using POC, alone or in combination, were compared with patients using stationary concentrators alone (aSC), or compressed tanks (CTC) or liquid oxygen (LO2), matched on the basis of age, gender, comorbidities, and stationary concentrator use. Among 244,719 LTOT patients (mean age 75 ± 12, 48% women) included, 38% used aSC, 46% mobile oxygen in the form of LO2 (29%) and POC (18%), whereas 9% used CTC. The risk of death over the 72-month follow-up was estimated to be 13%, 15%, and 12% lower for patients in the POC group compared to aSC, CTC, and LO2, respectively. In the POC group yearly mean total costs per patient were 5% higher and 4% lower compared to aSC and CTC groups, respectively, and comparable in the LO2 group. The incremental cost-effectiveness ratio (ICER) of POC was €8895, €6288, and €13,152 per year of life gained compared to aSC, CTC, and LO2, respectively. Within the POC group, we detected an association between higher mobility (POCs autonomy higher than 5h), improved survival, lower costs, and ICER - €6 238, compared to lower mobility POCs users.

INTRODUCTION: The COVID-19 pandemic has had a profound impact on a global scale, affecting various aspects of society, health, and well-being. It has strained healthcare systems and led to social and welfare repercussions. In the context of post-acute COVID-19 rehabilitation, there is a need to explore effective interventions for individuals, particularly those with chronic respiratory insufficiency. This study aims to evaluate the effectiveness of exercise reconditioning as a rehabilitation strategy in this specific population METHODS: A retrospective observational study was conducted at the Rehabilitation Unit in an Italian hospital between March 2020 and May 2022. The study included individuals who had been diagnosed with COVID-19 pneumonia, required hospitalization in the COVID-19 unit or intensive care unit (ICU) due to severe respiratory failure and with “post-COVID pathology syndrome” (PCS) picture. Various assessments, including the 6 Minutes Walking Test (6MWT), were conducted to determine exercise capacity. A personalized reconditioning program based on international guidelines was designed for each patient, focusing on aerobic training. Measurements of vital signs were taken during training sessions. RESULTS: A total of 24 individuals, with a mean age of 65.41 years, were included in the study. The average duration of hospitalization in the rehabilitation department was 53.17 days. Most participants had pre-existing respiratory and non-respiratory pathologies. All individuals developed COVID-19 interstitial pneumonia, and some required intensive interventions such as intubation or ECMO support. Pulmonary fibrosis and Critical Illness Myopathy (CIM) were observed in a significant portion of the participants. Significant improvements were observed in the 6MWT distance traveled, Functional Independence Measure (FIM) scale score, fraction of inhaled oxygen (FiO2), and dyspnea scores. Perceived exerction measures also showed positive changes. DISCUSSION AND CONCLUSION: The findings of this study indicate that personalized reconditioning plan is effective in improving the functional capacity and overall condition and quality of life of individuals with post-COVID pathology syndrome. These findings highlight the importance of an interdisciplinary approach and tailored rehabilitation programs in this population. Further research is needed to explore the long-term effects of exercise reconditioning in this population.

ZusammenfassungDie chronisch respiratorische Insuffizienz wird auch in der Pädiatriezunehmend ambulant mit außerklinischer Beatmung behandelt. Die oftkomplex, erkrankten Kinder werden in der Häuslichkeit durch pflegerischeund ärztliche Teams unterschiedlichster Zusammensetzung betreut.Strukturierte Behandlungsprozesse, speziell Notfallpläne zum Managementdes respiratorischen Notfalls von außerklinisch beatmeten Kindernfehlen. Dieser Beitrag ist ein Vorschlag zum Notfallmanagement beiAtemwegsinfekten, Notfällen bei außerklinischnicht-invasiv-beatmeten und invasiv-beatmeten, tracheotomierten Kindern. Nebenden Reanimationsmaßnahmen nach ERC/AHA liegt der Schwerpunkt vorallem auf dem Sekretmanagement, aber auch dem Umgang mitBeatmungsgeräten und Devices.