Overnight variation in tidal expiratory flow limitation in COPD patients and its correction: an observational study

Background Tidal expiratory flow limitation (EFLT) is common among COPD patients. Whether EFLT changes during sleep and can be abolished during home ventilation is not known. Methods COPD patients considered for noninvasive ventilation used a ventilator which measured within-breath reactance change at 5 Hz (∆Xrs) and adjusted EPAP settings to abolish EFLT. Participants flow limited (∆Xrs > 2.8) when supine underwent polysomnography (PSG) and were offered home ventilation for 2 weeks. The EPAP pressure that abolished EFLT was measured and compared to that during supine wakefulness. Ventilator adherence and subjective patient perceptions were obtained after home use. Results Of 26 patients with supine EFLT, 15 completed overnight PSG and 10 the home study. In single night and 2-week home studies, EFLT within and between participants was highly variable. This was unrelated to sleep stage or body position with only 14.6% of sleep time spent within 1 cmH2O of the awake screening pressure. Over 2 weeks, mean EPAP was almost half the mean maximum EPAP (11.7 vs 6.4 cmH2O respectively). Group mean ∆Xrs was ≤ 2.8 for 77.3% of their home use with a mean time to abolish new EFLT of 5.91 min. Adherence to the ventilator varied between 71 and 100% in prior NIV users and 36–100% for naïve users with most users rating therapy as comfortable. Conclusions Tidal expiratory flow limitation varies significant during sleep in COPD patients. This can be controlled by auto-titrating the amount of EPAP delivered. This approach appears to be practical and well tolerated by patients. Trial registration: The trial was retrospectively registered at CT.gov NCT04725500.

TO AVOID AIR BORN INFECTION IN TODAYS ERA AT URBAN AREA NEEDS PROPER HOME VENTILATION WITH RESPECT TO VENTILATION AND CORONAVIRUS (COVID-19)

With the outbreak of deadly Coronavirus in China and other parts of the world, experts suggest that staying in well-ventilated areas can avert infection by the virus. The 1990s decade was the warmest and the year 1998 was the warmest recorded since 1861. More than half of the 110 known Harlequin frog species have vanished due to climate change and global warming. 14.6 million hectares of natural forest are lost each year in an area than England. Because of the rising temperature, polar bears are waking up early from their winter slumber. When they are not able to hibernate, they become grouchy and increasingly aggressive. UN secretary called climatically changes as the biggest challenge of 21stcenture. Exactly the changes worsen the lifestyle of manhood life and animal kingdom also. In 2020 we are facing Covid19 Pandemic crisis in the Urban-rural area. In an urban area, people are affected by this pandemic more than rural people. The environmental researchers stated in various studies that urban people are living in congested air due to inflation and lack of space for living to compare to the rural people. The urban public has a lack of ventilation in structural development. To Avoid Air Born Infection In Today’s Era at Urban Area Needs Proper Home Ventilation with respect to Ventilation and Coronavirus (COVID-19). If you are using an air purifier, people must also ensure proper maintenance by following the advice of the manufacturer. If fans are used, they should be mounted where room air can be exhausted directly through a window into the outside area. Another way to reduce the spread of viruses according to experts is by letting fresh air in by keeping windows and doors open.

Quality of life during the epidemic of COVID-19 and its associated factors among enterprise workers in East China

Background The COVID-19 related lockdown and home confinement might have an important impact on the quality of life in enterprise workers. We investigated the quality of life during the epidemic in enterprise workers who just returned to work, and assessed its potential influencing factors to have a better understanding of the impact of COVID-19 epidemic lockdown and home confinement. Methods This was a cross-sectional study of enterprise workers conducted in Deqing and Taizhou, Zhejiang Province, China. The Chinese version of EQ5D was used to assess life quality, and information about general characteristics and COVID-19 related factors was collected by a structured questionnaire, which was distributed through the social application “WeChat”. Multiple liner regression was used to investigate potential influencing factors. Results A total of 2420 participants were enrolled, 59.5% of which worked in Deqing. About 50% of the participants reported worries about the COVID-2019 epidemic and 40.2% had a centralized or home quarantine during the epidemic. The mean EQ-5D score and VAS were 0.990 and 93.5. Multiple liner regression showed that the quality of life measures was related to physical activities (β = 0.006) and keeping home ventilation (β = 0.063) in Deqing, and were related to wearing a mask when going out (β = 0.014), keeping home ventilation (β = 0.061), other marital status (β = − 0.011), worry about the epidemic (β = − 0.005) and having a centralized or home quarantine (β = − 0.005) in Taizhou. Conclusions The quality of life for returning enterprise workers in areas with different risks of COVID-19 was affected by different factors. Associated factors identified from this study would help develop proper intervention measures for enterprise workers to reduce the impact of large-scale public health events like the COVID-19 on their quality of life.

Factors That Impact the Timing and Removal of Gastrostomy Placement/Nissen Fundoplication in Children with Bronchopulmonary Dysplasia

Objective The study aimed to identify factors that impact timing of gastrostomy placement/removal and Nissen fundoplication (NF) in infants with bronchopulmonary dysplasia (BPD). Study Design Clinical data were reviewed retrospectively from patients recruited from the Johns Hopkins Bronchopulmonary Dysplasia Clinic (January 1, 2014–December 31, 2018). Results Patients with gastrostomy tubes (GTs) placed in the neonatal intensive care unit (NICU) were older at discharge (p < 0.001) and less likely to have abnormal upper gastrointestinal series findings (p = 0.005) than those with GTs placed after NICU discharge. Patients with NF had lower mean gestational ages (p = 0.011), longer NICU stays (p = 0.019), more frequent home ventilation requirements (p = 0.005), and greater likelihood of pulmonary hypertension (p = 0.032) compared with those without. Median age of GT removal was 61.6 months. Patients with GTs were weaned from supplemental oxygen and/or home ventilation before GT removal (p < 0.001). Conclusion Patients with GT/NF were more medically complex than those with GT alone. Patients were more likely to be weaned from home respiratory support before GT removal. Key Points