Publications by authors named "Gregory Reychler"

97 Publications

Follow-up of functional exercise capacity in patients with COVID-19: It is improved by telerehabilitation.

Respir Med 2021 07 30;183:106438. Epub 2021 Apr 30.

Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium; Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address:

Background: The impact of the COVID-19 pandemic on functional exercise capacity seemed quickly clinically evident. The objective of this study was to assess the functional exercise capacity of patients with severe COVID-19 and to evaluate the effect of a telerehabilitation program in the specific context of the COVID-19 pandemic.

Method: Patients hospitalized for severe or critical COVID-19 were recruited. The functional exercise capacity (1-min sit-to-stand test (STST)) was prospectively quantified at discharge. A telerehabilitation program was then proposed. A control group was composed with the patients refusing the program.

Results: At discharge, none of the 48 recruited patients had a STST higher than the 50th percentile and 77% of them were below the 2.5th percentile. SpO2 was 92.6 ± 3.0% after STST and 15 patients had oxygen desaturation. After 3-months of follow-up, the number of repetitions during STST significantly increased either in telerehabilitation (n = 14) (p < 0.001) or in control groups (n = 13) (p = 0.002) but only one patient had a result higher than the 50th percentile (in Telerehabilitation group) and 37% of them were still under the 2.5th percentile for this result. The improvement was significantly and clinically greater after the telerehabilitation program (p = 0.005). No adverse events were reported by the patients during the program.

Conclusions: Patients hospitalized for COVID-19 have a low functional exercise capacity at discharge and the recovery after three months is poor. The feasibility and the effect of a simple telerehabilitation program were verified, this program being able to substantially improve the functional recovery after three months.
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http://dx.doi.org/10.1016/j.rmed.2021.106438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084600PMC
July 2021

Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire.

Muscle Nerve 2021 Apr 23. Epub 2021 Apr 23.

Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.

Introduction/aims: Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharyngeal dysphagia in various NMD groups and diseases. Finally, we compared results of this screening with those from their corresponding medical records for eventual "clinical history" of dysphagia.

Methods: We asked patients to fill in the SSQ during follow-up outpatient visits at our neuromuscular reference center. A total score above the cutoff score of 118.5 out of 1700 was indicative of oropharyngeal dysphagia.

Results: Of the 304 adult patients assessed for eligibility, 201 NMD patients (96 women and 105 men, aged 49.0 ± 16.2 years) were included and tested in this study. Oropharyngeal dysphagia was detected in 45% of all the NMD patients when using the SSQ, whereas only 12% had a positive medical record for dysphagia. The median SSQ scores for patients with myotonic syndromes (including myotonic dystrophy type 1), with amyotrophic lateral sclerosis, and with facioscapulohumeral dystrophy were above the cutoff score. The SSQ scores obtained revealed distinct oropharyngeal dysphagia characteristics in the different NMD groups and diseases.

Discussion: The SSQ tests positively for oropharyngeal dysphagia in a higher proportion of NMD patients compared with their medical records. The distinct oropharyngeal dysphagia characteristics we revealed in different NMD groups and diseases may help to elaborate adapted clinical approaches in the management of oropharyngeal dysphagia.
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http://dx.doi.org/10.1002/mus.27254DOI Listing
April 2021

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.

Respir Med 2021 05 4;181:106383. Epub 2021 Apr 4.

Radiology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Belgium.

Background: COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected.

Research Question: We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or abnormalities in pulmonary function tests (PFT) or in lung imaging.

Study Design: and methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT.

Results: Full clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea.

Interpretation: Although most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.
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http://dx.doi.org/10.1016/j.rmed.2021.106383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019490PMC
May 2021

What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review.

BMC Sports Sci Med Rehabil 2021 Mar 25;13(1):33. Epub 2021 Mar 25.

Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab, Université catholique de Louvain, Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium.

Background: Substantial postoperative complications occur after tumor resection for esophagogastric cancers. Physical prehabilitation programs aim to prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications. This systematic review aims to summarize the effects of physical prehabilitation programs on exercise capacity, muscle strength, respiratory muscle function, postoperative outcomes, and health-related quality of life and to determine the optimal design of such a program to improve these outcomes in esophagogastric cancer patients undergoing tumor resection.

Methods: A systematic literature review was conducted using PubMed, The Cochrane Library, Scopus, and PEDro databases to identify studies evaluating the effects of physical prehabilitation program on exercise capacity, muscle strength, respiratory muscle function, postoperative complications, length of hospital stay, mortality, and health-related quality of life in patients with esophagogastric cancer awaiting surgery. Data from all studies meeting the inclusion criteria were extracted. The quality of each selected study was determined using the Downs and Black checklist.

Results: Seven studies with 645 participants were included. The preoperative exercise program consisted of respiratory training alone in three studies, a combination of aerobic and resistance training in two studies, and a combination of respiratory, aerobic, and resistance training in two studies. Training frequency ranged from three times a day to twice a week and each session lasted between 20 and 75 min. Four studies were of fair quality and three of good quality. Some studies reported improvements in maximal inspiratory pressure, inspiratory muscle endurance, postoperative (pulmonary) complications, and length of hospital stay in the preoperative exercise group compared to the control group.

Conclusion: This systematic review reports the current evidence for physical prehabilitation programs in patients with esophagogastric cancer awaiting surgery. However, due to the limited number of randomized controlled trials, the significant heterogeneity of exercise programs, and the questionable quality of the studies, higher quality randomized controlled trials are needed.

Trial Registration: PROSPERO Registration Number: CRD42020176353 .
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http://dx.doi.org/10.1186/s13102-021-00260-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993458PMC
March 2021

Measurement properties of the one-minute sit-to-stand test in children and adolescents with cystic fibrosis: A multicenter randomized cross-over trial.

PLoS One 2021 12;16(2):e0246781. Epub 2021 Feb 12.

Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels, Brussels Capital Region, Belgium.

Background: Functional exercise capacity assessment is recommended in children with cystic fibrosis (CF). The six-minute walk test (6MWT) is a valid evaluation of exercise capacity but can be technically complex. Inversely, the sit-to-stand test (STST) is a simple method to evaluate exercise capacity, and is validated in healthy children and adults with CF. This study aimed to evaluate STST measurement properties in children and adolescents with CF.

Methods: In this multicenter study, children with CF (6 to 18 years) performed two iterations of both the STST and the 6MWT in a randomized order. Criterion validity was determined by assessing correlations between STST repetitions and 6MWT distance (6MWD). Intra-rater reliability, test-retest repeatability, mean bias and limits of agreement were also assessed. Relationships with other outcomes (i.e. respiratory and quadriceps muscle strength) and cardio-respiratory responses were analysed for both tests.

Results: Thirty-six children with CF were included (mean age 12.0 ±3.5 years and FEV1 95.8 ±25.0%). On average, 39.6 ±10.5 repetitions were performed during the STST and mean 6MWD was 596.0 ±102.6 meters. STST number of repetitions was significantly correlated with 6MWD (r = 0.48; p<0.01). Both tests had very good intra-rater reliability (ICCSTST = 0.91 (95%CI 0.76-0.96) and ICC6MWT = 0.94 (95%CI 0.85-0.97)), and a significant test-retest learning effect. The number of STST repetitions was not correlated with quadriceps or respiratory muscle strength test, and the STST induced fewer cardio-respiratory responses than the 6MWT.

Conclusions: The STST is an easy-to-use functional test with moderate criterion validity when compared to the 6MWT in children with CF, probably because both tests measure different components of functional exercise capacity. The STST is useful when the 6MWT is unfeasible, however further investigations are required to explore the clinical implications of STST results in children with CF.

Clinical Trial Registration: NCT03069625.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246781PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880481PMC
February 2021

Oxygen uptake kinetics during treadmill walking in adolescents with clinically stable cystic fibrosis.

Physiother Theory Pract 2021 Jan 4:1-9. Epub 2021 Jan 4.

Institut De Recherche Et d'Expérimentation Clinique (IREC), Pôle De Pneumologie, ORL and Dermatologie, Université Catholique De Louvain, Brussels, Belgium.

: Oxygen uptake (V̇O) kinetics have been shown to be slowed in adolescents with cystic fibrosis (CF) during heavy-intensity cycling and maximal exercise testing.: This study investigated V̇O kinetics in adolescents with CF compared to control adolescents (CON) during a treadmill-walking exercise.: Eight adolescents with CF and mild-to-moderate pulmonary obstruction (5 girls; 13.1 ± 2.5 years; FEV 67.8 ± 21.4%) and 18 CON adolescents (10 girls; 13.8 ± 1.8 years) were recruited. Pulmonary gas exchange and ventilation were measured during a single transition of 10 min of treadmill walking and a 5 min seated recovery period. Participant's walking speed was determined during a one-minute self-paced walking task along a 50-m corridor. A six-parameter, non-linear regression model was used to describe the changes in V̇O function during the treadmill walking and recovery, with monoexponential curve fitting used to describe the mean response time (MRT) at the onset of exercise, and the half-life (TV̇O) at the offset of exercise. V̇O baseline and amplitude, minute ventilation and respiratory equivalents were recorded.: V̇O kinetics were slower in CF group compared to CON group during the treadmill walking with a greater MRT (32 ± 14 s vs 21 ± 16 s; = .04, effect size = 0.75). The TV̇O2 was prolonged during recovery in CF group compared to CON group (86 ± 24 s vs 56 ± 22 s; = .04, effect size = 1.31). The mean VE/V̇CO during exercise was the only parameter significantly greater in CF group compared to CON group (32.9 ± 2.3 vs 29.0 ± 2.4; < .01, effect size = 1.66). : V̇O kinetics were found to be slowed in adolescents with CF during treadmill walking.
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http://dx.doi.org/10.1080/09593985.2020.1868029DOI Listing
January 2021

Chest Expansion and Lung Function for Healthy Subjects and Individuals With Pulmonary Disease.

Respir Care 2021 Apr 29;66(4):661-668. Epub 2020 Dec 29.

Service de Pneumologie, Cliniques Universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium.

Background: The purposes of this study were to verify the correlation between chest expansion and lung function within a larger sample of subjects composed of both healthy subjects and subjects affected by pulmonary disease, and to verify the influence of age, body mass index, and gender on chest expansion.

Methods: Adults were recruited prospectively when they visited the lung function lab. Chest expansion was measured with a measuring tape at 2 different levels of the rib cage by 1 blinded examiner. Spirometry was performed for each subject.

Results: Data from 251 subjects between 18 and 88 y old were collected and analyzed. Among the analyzed subjects, mean upper and lower chest expansion were 4.82 ± 1.84 cm and 3.99 ± 2.15 cm, respectively. A significant but poor correlation was found between both chest expansion and all lung function parameters (total lung capacity, FVC, and FEV) ( = .01). Negative significant correlations were found between chest expansion and age as well as body mass index. The difference in upper chest expansion between obese and nonobese subjects was not statistically significant, but the difference in lower chest expansion was significant for these 2 groups. Finally, upper and lower chest expansion were not different between males and females.

Conclusions: Based on these results, one cannot validate the use of chest expansion measurement to define lung function. In centers that have easy access to more precise and complete methods to measure lung function, the measurement of chest expansion for diagnostic purposes seems to be archaic. Additionally, age and body mass index are 2 parameters that can influence chest expansion.
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http://dx.doi.org/10.4187/respcare.08350DOI Listing
April 2021

Effects of rehabilitation methods on lower-limb muscle function and functional performance in patients with cystic fibrosis: A systematic review.

Clin Rehabil 2021 Apr 23;35(4):534-545. Epub 2020 Nov 23.

Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et dermatologie, Université Catholique de Louvain, Brussels, Belgium.

Objective: To investigate the effects of rehabilitation methods on leg muscle function and functional performance in cystic fibrosis.

Data Sources: A literature search was conducted in PubMed (MEDLINE), Scopus and the Cochrane Library from inception to October 12, 2020. A secondary hand search through reference lists from identified articles was conducted.

Review Methods: Three authors independently checked the full-text copies for eligibility of relevant articles. Randomized controlled trials were included. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The PRISMA guidelines were followed. Results suggestive of leg muscle function (e.g. strength, power, endurance, and fatigue) and functional performance were reported.

Results: The search identified 8 studies (233 patients). The overall quality of these articles was good. Rehabilitation modalities investigated were physical exercises (aerobic, anaerobic and resistance training) ( = 7) and neuromuscular electrical stimulation ( = 1). Most studies ( = 4) reported on the effects of combined aerobic and resistance training and showed improvement on leg strength when exercises were supervised. Aerobic training alone or the use of neuromuscular electrical stimulation also enhanced leg strength, whereas anaerobic training did not. Two studies evaluated leg fatigue and found no improvement compared to standard care. One study assessed the effect of exercises on functional performance and found no improvement when compared to standard care. No studies emphasized the impact of rehabilitation methods on leg muscle endurance or power.

Conclusion: Combined aerobic and resistance training enhances leg muscle strength in cystic fibrosis. There is insufficient data on other leg muscle outcomes, nor on alternative rehabilitation strategies.
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http://dx.doi.org/10.1177/0269215520972941DOI Listing
April 2021

Impact of an Improvised System on Preserving Oxygen Supplies in Patients With COVID-19.

Arch Bronconeumol 2021 Jan 27;57 Suppl 1:77-79. Epub 2020 Aug 27.

Service de Médecine Interne et Maladies Infectieuses, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Louvain Centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique (IREC), Université Catholique de Louvain, Avenue Hippocrate 55, 1200 Brussels, Belgium.

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http://dx.doi.org/10.1016/j.arbres.2020.07.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450946PMC
January 2021

Effects of high-intensity interval training compared with resistance training in prostate cancer patients undergoing radiotherapy: a randomized controlled trial.

Prostate Cancer Prostatic Dis 2021 Mar 27;24(1):156-165. Epub 2020 Jul 27.

Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.

Background: Exercise training has shown beneficial effects in the management of radiotherapy-related side effects in prostate cancer (PCa) patients undergoing radiation therapy (RT). However, the optimal modality of the exercise programs have not been yet determined. The aim of this randomized controlled trial was to investigate the effects of high-intensity interval training (HIIT) and resistance training (RES) compared to usual care (UC) on cancer-treatment-related fatigue (CTRF) (primary outcome), quality of life, depression, daytime sleepiness, insomnia, sleep quality, functional exercise capacity and executive function in PCa patients during RT.

Methods: PCa patients undergoing RT with or without ADT were randomized in HIIT, RES or UC. Both exercise programs included three sessions per week during 5-8 weeks. HIIT consisted of 8-15 × 60 s intervals (≥85% maximal heart rate). RES was performed with 1-3 sets of 8-12 repetitions for each large muscle groups. The primary outcome was changed in CTRF measured with the Functional Assessment of Chronic Illness Therapy-Fatigue.

Results: Seventy-two subjects (69.1 ± 8.2 years) completed the study. No exercise-related adverse events occurred. HIIT (p = 0.012) and RES (p = 0.039) training attenuated increases in CTRF compared to UC. Functional exercise capacity, evaluated by the 6-min walk test, increased after HIIT (p = 0 = 0.43) and RES (p = 0.041) compared to UC (+0.1%). No other secondary variables were different between groups.

Conclusions: Both intervention groups displayed beneficial effects on CTRF and functional exercise capacity in PCa patients undergoing RT. In addition, HIIT and RES are both safe with an excellent attendance rate to the exercise sessions.
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http://dx.doi.org/10.1038/s41391-020-0259-6DOI Listing
March 2021

Feasibility and Preliminary Effectiveness of a Tele-Prehabilitation Program in Esophagogastric Cancer Patients.

J Clin Med 2020 Jul 9;9(7). Epub 2020 Jul 9.

Upper Gastrointestinal Surgery Unit, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.

Tele-rehabilitation provides better access to healthcare services and optimizes exercise adherence. However, its feasibility and effectiveness are unknown in the preoperative period in esophagogastric cancer patients. We aimed to assess the feasibility and the preliminary effects of a "tele-prehabilitation" program in esophagogastric cancer patients requiring surgery. Enrolled participants performed an internet-based tele-prehabilitation including aerobic, resistance and inspiratory muscle training over 2-4 weeks. The primary outcome was feasibility, measured in terms of recruitment, retention and attendance rates, adverse events and patient satisfaction. Secondary outcomes (functional exercise capacity, fatigue, quality of life, anxiety and depression) were assessed at baseline, presurgery, and 4 and 12 weeks postsurgery. Among the 24 eligible subjects, 23 were enrolled, 22 performed the intervention and 15 completed the study. Recruitment and retention rates were both 96%. Attendances to aerobic and resistance sessions and inspiratory muscle training were 77% and 68%, respectively. No adverse events occurred, and the satisfaction was excellent. After prehabilitation, participants significantly improved fatigue ( = 0.039), quality of life ( = 0.009), physical well-being ( = 0.034), emotional well-being ( = 0.005) and anxiety ( = 0.044). This study demonstrated the feasibility of a tele-prehabilitation in esophagogastric cancer patients undergoing surgery, with a high recruitment rate, retention rate and satisfaction, a good attendance to exercise sessions and no exercise-related adverse events.
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http://dx.doi.org/10.3390/jcm9072176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408844PMC
July 2020

Effects of exercise therapy in cancer patients undergoing radiotherapy treatment: a narrative review.

SAGE Open Med 2020 17;8:2050312120922657. Epub 2020 Jun 17.

Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.

Despite its beneficial effects, radiotherapy still results in a range of side effects that negatively impact quality of life of patients. Exercise has been shown to counteract the side effects induced by cancer treatment. This narrative review aims to provide an up-to-date review of the effects of an exercise intervention in cancer patients during radiotherapy. A literature search was performed on PubMed to identify original articles that evaluated the effects of an exercise programme to alleviate treatment-related side effects in cancer patients undergoing radiotherapy with or without other cancer treatments. Benefits related to exercise training have been shown in breast, prostate, rectal, lung, head and neck cancer patients undergoing radiotherapy. Therefore, exercise should be considered as a concurrent treatment alongside radiotherapy to alleviate treatment-related side effects and facilitate effective recovery. Due to the onset and progress of treatment-related side effects throughout radiotherapy, a regular clinical evaluation seems strongly advisable in order to continuously adapt the exercise programme depending on symptoms and side effects. An exercise professional is needed to personalize exercise training based on the medical condition and tailor it throughout the intervention according to progress and the patient's medical status. Future studies are needed to confirm the potential benefits of exercises observed on treatment-related side effects. Furthermore, because of the narrative design of this study, a systematic review is required to evaluate the strength of the evidence reported.
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http://dx.doi.org/10.1177/2050312120922657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301662PMC
June 2020

Predictive model for the 1-minute sit-to-stand test in healthy children aged 6 to 12 years.

Ann Phys Rehabil Med 2021 Mar 16;64(2):101410. Epub 2020 Jul 16.

Service de médecine physique et readaptation, cliniques universitaires Saint-Luc, Bruxelles, Belgium.

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http://dx.doi.org/10.1016/j.rehab.2020.05.013DOI Listing
March 2021

Clinimetric evaluation of muscle function tests for individuals with cystic fibrosis: A systematic review.

J Cyst Fibros 2020 11 11;19(6):981-995. Epub 2020 Jun 11.

Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels1200, Belgium; Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinics, Brussels1200, Belgium.

Accurate testing of muscle function is essential in individuals with cystic fibrosis (CF). A literature search was conducted in MEDLINE, CENTRAL, CINAHL, PEDro, ScienceDirect and Web of Science according to PRISMA and COSMIN guidelines from inception to September 2019 to investigate the clinimetric properties of muscle tests in individuals with CF. The search identified 37 studies (1310 individuals) and 34 different muscle tests. Maximal inspiratory pressure, inspiratory work capacity and quadriceps strength measured by computerised dynamometry were identified as reliable tests of muscle function. The one-minute sit-to-stand test was found to have high reliability but its validity to measure quadriceps strength is unknown. The clinimetric properties of other routinely used tests have not been reported in people with CF. Very different measurement procedures were identified. Inspiratory muscle and quadriceps testing can be considered as reliable but high-quality studies evaluating tests of other muscles function (e.g. muscle endurance) are lacking.
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http://dx.doi.org/10.1016/j.jcf.2020.05.014DOI Listing
November 2020

NIV Is not Adequate for High Intensity Endurance Exercise in COPD.

J Clin Med 2020 Apr 8;9(4). Epub 2020 Apr 8.

Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, 76000 Rouen, France.

Noninvasive ventilation (NIV) during exercise has been suggested to sustain higher training intensity but the type of NIV interface, patient-ventilator asynchronies (PVA) or technological limitation of the ventilator may interfere with exercise. We assessed whether these parameters affect endurance exercise capacity in severe COPD patients. In total, 21 patients with severe COPD not eligible to home NIV performed three constant workload tests. The first test was carried out on spontaneous breathing (SB) and the following ones with NIV and a nasal or oronasal mask in a randomized order. PVA and indicators of ventilator performance were assessed through a comprehensive analysis of the flow pressure tracing raw data from the ventilator. The time limit was significantly reduced with both masks (406 s (197-666), 240 s (131-385) and 189 s (115-545), < 0.01 for tests in SB, with oronasal and nasal mask, respectively). There were few PVA with an oronasal mask (median: 3.4% (1.7-5.2)) but the ventilator reached its maximal generating capacity (median flowmax: 208.0 L/s (189.5-224.8) while inspiratory pressure dropped throughout exercise (from 10.1 (9.4-11.4) to 8.8 cmH2O (8.6-10.8), < 0.01). PVA were more frequent with nasal mask (median: 12.8% (3.2-31.6), < 0.01). Particularly, the proportion of patients with ineffective efforts > 10% was significantly higher with nasal interface (0% versus 33.3%, < 0.01). NIV did not effectively improve endurance capacity in COPD patients not acclimated to home NIV. This was due to a technological limitation of the ventilator for the oronasal mask and the consequence either of an insufficient pressure support or a technological limitation for the nasal mask.
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http://dx.doi.org/10.3390/jcm9041054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230463PMC
April 2020

Energy conservation technique improves dyspnoea when patients with severe COPD climb stairs: a randomised crossover study.

Thorax 2020 06 26;75(6):510-512. Epub 2020 Mar 26.

R&D, AGIR à dom, Meylan, France.

In this randomised, crossover trial, 22 patients with severe chronic obstructive pulmonary disease climbed six flights of stairs (108 steps) twice, under two test conditions: (1) energy conservation technique (ECT): participants were asked to rest for at least 5 seconds every three steps and (2) control condition: participants climbed the stairs at their own pace. Significant lower dyspnoea (primary outcome), leg discomfort, minute ventilation and capillary blood lactate under the ECT condition were found, with no change in total task time. CLINICAL TRIAL REGISTRATION: NCT03564028.
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http://dx.doi.org/10.1136/thoraxjnl-2019-214295DOI Listing
June 2020

Improvement of arterial oxygenation using the double trunk mask above low flow nasal cannula: a pilot study.

J Clin Monit Comput 2021 02 14;35(1):213-216. Epub 2020 Feb 14.

Institut de Recherche Expérimentale Et Clinique (IREC), Pole de Pneumologie, ORL & Dermatologie, Service de Pneumologie, Université Catholique de Louvain, Brussels, Belgium.

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http://dx.doi.org/10.1007/s10877-020-00485-zDOI Listing
February 2021

Thorpe tube and oxygen flow restrictor: what's flow accuracy?

J Clin Monit Comput 2021 Apr 10;35(2):337-341. Epub 2020 Feb 10.

Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Service de Pneumologie, Université Catholique de Louvain, Bruxelles, Belgium.

Oxygen gas flowmeters (OGF) are used to regulate the oxygen flow in acute and chronic care. In hospitals, Thorpe tubes (TT) are the classical systems most used for delivering oxygen. In recent years, the oxygen flow restrictor (OFR) has appeared. These devices use a series of calibrated openings in a disk that can be adjusted to deliver different flow rates. These devices have a reputation for delivering more accurate oxygen flow rates compared to classical OGFs. However, to our knowledge, few study has examined this supposition. This study aimed to compare and evaluate the accuracy and precision of the ready-to-use TTs and OFRs. OGFs were selected from hospitals in Belgium and France. Before performing the flow measurements, the inlet pressure was checked. The accuracy of the OGF was analyzed with a calibrated thermal mass flowmeter (RED Y COMPACT™ GCM-0 to 20 L/min-VÖGTLIN Instruments). Different flows (2, 4, 6, 9 or 12 L/min) were evaluated. Linear regression analysis, bias (with confidence interval) and lower and upper limit of the agreement were calculated for TTs and OFRs. All measurements are expressed in absolute values. Four-hundred-seventy-six TTs and 96 OFRs were analyzed. The intra-class correlation coefficient calculated for the calibrated thermal mass flowmeter was > 0.99 and reflected the excellent reliability of our measurements. For TTs, the bias value was - 0.24 L/min (± 0.88), and the limits of agreement were - 1.97 to 1.48 L/min. For OFRs, the bias value was - 0.30 L/min (± 0.54), and the limits of agreement were - 1.36 to 0.77 L/min. As the flow increased, the accuracy of all analyzed OGFs decreased. With the increasing flow, some data fell outside the limits of agreement, and the trend increased with the elevated oxygen flow. TTs were less accurate compared to OFRs due to the increased flow variability. However, for TTs and OFRs, as the required flow is elevated, the dispersion of values increases on both sides of the actual flow.
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http://dx.doi.org/10.1007/s10877-020-00476-0DOI Listing
April 2021

Impact of hypertonic saline nebulisation combined with oscillatory positive expiratory pressure on sputum expectoration and related symptoms in cystic fibrosis: a randomised crossover trial.

Physiotherapy 2020 06 11;107:243-251. Epub 2019 Nov 11.

Universidad San Jorge, Autovía Mudéjar, km. 299, Villanueva de Gállego, 50830, Zaragoza, Spain. Electronic address:

Objective: To evaluate the impact of combining nebulised hyaluronic acid plus hypertonic saline (HA+HS) with oscillatory positive expiratory pressure (oscillatory-PEP) on sputum expectoration and related symptoms in adults with cystic fibrosis (CF).

Design: Randomised crossover trial.

Setting: Seven centres.

Participants: Twenty-two outpatients with CF.

Interventions: Usual care (HA+HS followed by autogenic drainage) and combined therapy (HA+HS with oscillatory-PEP followed by autogenic drainage]. Each treatment was performed for 5 days.

Main Outcome Measures: Sputum expectoration was measured during the nebulisation period (primary outcome), during autogenic drainage and for 24hours post intervention. The Cough and Sputum Assessment Questionnaire (CASA-Q) and its domains (cough symptoms, cough impact, sputum symptoms and sputum impact), the Leicester Cough Questionnaire (LCQ) and lung function tests were used. Tolerance and patient preference were registered.

Results: Twenty-two participants [mean age 25 (standard deviation 8) years, percentage predicted forced expiratory volume in 1second 67 (22)] were recruited. Combined therapy promoted greater sputum expectoration than usual care during the nebulisation period {median difference 1.8ml [95% confidence interval (CI) 0.2-6.2]}. Both treatments led to similar expectoration during autogenic drainage and for 24hours post intervention. Combined therapy led to a greater improvement in the sputum symptoms domain [6.7 points (95% CI 3.3-13.3] and total CASA-Q score [2.4 points (95% CI 0.1-9.3)] compared with usual care. No differences in LCQ score or lung function were observed. Fewer adverse events were reported using combined therapy, which was selected as the preferred intervention.

Conclusions: Combined nebulisation increased immediate sputum expectoration, improved sputum symptoms and reduced adverse events compared with usual care in patients with CF.

Clinical Trial Number: NCT02303808.
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http://dx.doi.org/10.1016/j.physio.2019.11.001DOI Listing
June 2020

Preference of neuromuscular patients regarding equipment for daytime mouthpiece ventilation: A randomized crossover study.

Clin Respir J 2020 Mar 18;14(3):214-221. Epub 2019 Dec 18.

Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Pôle de Pneumologie, ORL & Dermatologie, Brussels, Belgium.

Background: Patients with neuromuscular disorders (NMDs) are likely to develop respiratory failure which requires noninvasive ventilation (NIV). Ventilation via a mouthpiece (MPV) is an option to offer daytime NIV.

Objectives: To determine the preferred equipment for MPV by patients with NMDs.

Methods: Two MPV equipment sets were compared in 20 patients with NMDs. Set 1, consisted of a non-dedicated ventilator for MPV (PB560, Covidien) with a plastic angled mouthpiece. Set 2, consisted of a dedicated MPV ventilator (Trilogy 100, Philips Respironics) without backup rate and kiss trigger combined with a silicone straw mouthpiece. The Borg dyspnea score, ventilator free time, transcutaneous oxygen saturation (SpO2) and carbon dioxide tension (TcCO ) were recorded with and without MPV. Patient perception was assessed by a 17-items list.

Results: Carbon dioxide tension measurements and total perception score were not different between the two MPV sets. Dyspnea score was lower with the non-dedicated versus dedicated equipment, 1 (0.5) versus 3 (1-6), P < 0.01. All patients with a ventilator free time lower than 6 hours preferred a set backup rate rather than a kiss trigger. Sixty five percent of patients preferred the commercial arm support and 55% preferred the plastic angled mouthpiece.

Conclusions: Dedicated and non-dedicated MPV equipment are deemed effective and comfortable. Individualization of arm support and mouthpiece is advised to ensure success of MPV. A ventilator free time lower than 6 hours seems to be a useful indicator to a priori set a backup rate rather than a rate at zero associated to the kiss trigger.
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http://dx.doi.org/10.1111/crj.13118DOI Listing
March 2020

Comparison of 6 Oscillatory Positive Expiratory Pressure Devices During Active Expiratory Flow.

Respir Care 2020 Apr 19;65(4):492-499. Epub 2019 Nov 19.

Service de Pneumologie, Cliniques universitaires Saint-Luc, and with the Institute of Experimental & Clinical Research - Pole of Pneumology, ENT, and Dermatology, Université catholique de Louvain, Brussels, Belgium.

Background: Air-flow oscillations generated by exhaling through oscillatory positive expiratory pressure (OPEP) devices favor airway clearance. Variations in mechanical properties between different devices may influence therapeutic efficacy. The objective of this study was to assess mechanical properties in vitro and to compare the performance of 6 OPEP devices at different resistance levels under active expiratory flow patterns.

Methods: 4 gravity-dependent OPEP devices (ie, Flutter, Gelomuc, Pari O-PEP, Shaker Medic Plus) and 2 gravity-independent OPEP devices (ie, Acapella Choice and Aerobika) were each tested at low, medium, and high resistance settings. All devices were independently connected to a pulmonary waveform generator that reproduced active exhalation flows. Expiratory flow-volume curves were retrieved from 4 subjects with different stages of obstruction severity and were scaled according to either peak expiratory flow (4, 6, and 8 L/s) or volumes (2, 3 and 4 L), thus amounting to 24 active exhalations. Resulting waveforms were divided into 4 parts and the 2 middle parts were used to extract the following mechanical data: positive expiratory pressure (PEP), maximum expiratory pressure (P), oscillation frequency, and flow oscillation amplitude. The percentage of tests achieving oscillation frequencies ≥ 12 Hz and PEP ≥ 10 cm HO was calculated for each device.

Results: Mechanistic effects of the Acapella, Aerobika, and Shaker devices were not comparable. The Flutter, Gelomuc, and Pari devices behaved similarly and achieved more tests with optimum oscillation frequency and PEP values than the other devices. These 3 devices also produced the highest oscillation amplitudes at the low-resistance level, whereas the Aerobika elicited higher and consistent oscillation amplitudes at medium and high resistance settings.

Conclusions: Operational parameters differed between and within devices, yet the Flutter, Gelomuc, and Pari devices were similar in many aspects. Therapeutic efficacy may depend on the selected OPEP device and set resistance.
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http://dx.doi.org/10.4187/respcare.07271DOI Listing
April 2020

Intrapulmonary percussive ventilation leading to 20-minutes breath-hold potentially useful for radiation treatments.

Radiother Oncol 2019 12 25;141:292-295. Epub 2019 Oct 25.

Pôle de Pneumologie, ORL & Dermatologie (PNEU), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium; Haute Ecole Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium; Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.

We developed a training protocol based on Intrapulmonary Percussive Ventilation in order to prolong breath-hold while nearly suppressing the thorax motion. This protocol allowed ten subjects to achieve a 20-minutes-breath-hold, while reducing the residual surface motion to 1 mm around its mean position for more than 95% of the breath-hold duration.
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http://dx.doi.org/10.1016/j.radonc.2019.09.024DOI Listing
December 2019

Comparison of 3-minute Step Test (3MStepT) and 6-minute Walk Test (6MWT) in Patients with COPD.

COPD 2019 08 5;16(3-4):266-271. Epub 2019 Sep 5.

Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain , Brussels , Belgium.

Chronic obstructive pulmonary disease (COPD) is frequently associated with a reduced functional exercise capacity. This parameter is usually evaluated using 6-minute walking test (6MWT). New tools appear regularly. The aim of this study was to validate the 3-minute step test (3MStepT) and to compare 3MStepT and 6MWT in stable patients with COPD as a tool to quantify the functional exercise capacity. Patients with COPD admitted for a pulmonary rehabilitation program in a dedicated center were recruited and randomly performed both tests: 6MWT and 3MStepT. A training test was performed systematically before each test. Walking distance and number of repetitions (3MStepT) were measured. Cardiorespiratory parameters, dyspnea and lower limb fatigue (Borg) were recorded pre and post the tests. Fifty patients with COPD (FEV1: 45.2 ± 18.3) were included. 6MWT (423.6 ± 96.3 m) was strongly correlated with 3MStepT (62.1 ± 18.0;  = 0.780;  < 0.001). Heart rate and SpO2 were significantly different at the end of the 6MWT and 3MStepT (respectively, 106.2 ± 16.3 vs. 112.9 ± 13.4bpm,  = 0.002; 87.6 ± 5.4 vs. 89.6 ± 5.3bpm,  = 0.001). Lower limb fatigue was significantly higher after the 3MStepT (2.5 ± 2.6 vs. 3.4 ± 2.4,  = 0.01). The 3MStepT is an alternative to the 6MWT to estimate functional exercise capacity in stable patients with COPD but cardiorespiratory adaptation and lower limb fatigue are not similar between these tests.
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http://dx.doi.org/10.1080/15412555.2019.1656713DOI Listing
August 2019

Targeted Lung Deposition From Nebulization Is Not Improved in the Lateral Decubitus Position in Healthy Volunteers.

Respir Care 2019 Dec 10;64(12):1537-1544. Epub 2019 Sep 10.

Service de Médecine Nucléaire, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

Background: Clinical benefits of inhaled therapies are related to the amount of drug deposited in the targeted area of the lung. Body positions that influence the distribution of lung ventilation should impact lung deposition of the nebulized drug. The aim of this study was to analyze the immediate effect of body position while the subject lies on his side (lateral decubitus) during nebulization on 3-dimensional total and regional lung deposition.

Methods: A randomized crossover trial was performed on healthy male volunteers without cardiovascular or pulmonary disease. A technetium-99m diethylenetriaminepentaacetic acid (Tc-DTPA) solution (4 mL) was nebulized using an individual-controlled inhalation system in left lateral decubitus and sitting positions with a 96-h washout period (43 inspirations of 4 s [ie, drug delivered until second 3] with a tidal volume of 0.8 L and a low inspiratory flow (200 mL/s). Drug deposition was followed with the use of planar images and single-photon-emission computed tomography combined with low-resolution computed tomography. Total and regional depositions were the main outcomes. Penetration index was also considered.

Results: Six participants (26.8 ± 6.9 y old) were included. Total lung deposition tended to be higher in a sitting position than in a lateral decubitus position: 10.2 ± 0.9% of nominal dose (95% CI 9.1-11.3) vs 8.6 ± 1.4% of nominal dose (95% CI 6.8-10.4) ( = .09). The deposition was significantly reduced in the dependent (left) lung in the lateral decubitus position: 3.5 ± 0.7% of nominal dose (95% CI 2.6-4.3) vs 4.7 ± 0.3% of nominal dose (95% CI 4.3-5.0) ( = .03). Penetration index was only influenced by body position for the dependent (left) lung ( = .043).

Conclusions: The total amount of drug delivered to the lungs during nebulization with an individual-controlled inhalation system tended to decrease when performed in the left lateral decubitus position. Moreover, contrary to the initial hypothesis, the deposition of particles in the dependent lung was not improved by the lateral decubitus position in this configuration. (ClinicalTrials.gov registration NCT02451501.).
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http://dx.doi.org/10.4187/respcare.06978DOI Listing
December 2019

Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study.

Respirology 2019 11 6;24(11):1088-1094. Epub 2019 Aug 6.

Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.

Background And Objective: We hypothesized that by reducing respiratory work and improving gas exchange, nasal high flow (NHF) would improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) following respiratory exacerbation.

Methods: This was a monocentric, randomized, controlled crossover study. Patients with severe to very severe COPD carried out two high-intensity constant work-rate exercise tests (CWRET) with and without NHF on two consecutive days. The primary outcome was the mean difference in endurance time between both conditions. The secondary aims included vastus lateralis oxygenation (StO ), dyspnoea, leg discomfort, maximal inspiratory pressure (MIP), transcutaneous CO pressure (PtcCO ), respiratory rate (RR), heart rate (HR) and pulsed O saturation (SpO ), as well as the patients' opinions of the device.

Results: A total of 19 patients were included (mean forced expiratory volume in 1 s = 28.7 ± 10.8%, age = 62.1 ± 9.1 years). No significant differences in endurance time during the CWRET were found between the two test conditions (-66.58 (95% CI: -155.9 to 22.7) s, P = 0.12). StO , PtCO and HR were reduced at the end of the exercise with NHF (-2.1% (95% CI: -4.3 to -0.0); -1.3 mm Hg (95% CI: -2.5 to -0.2); -2.7 bpm (95% CI: -5.0 to -0.5), respectively, P ≤ 0.05). No significant differences were found for any of the other secondary outcomes. Half of the patients evaluated the device as being moderately to very uncomfortable.

Conclusion: NHF during exercise did not increase endurance time in patients with COPD following exacerbation.

Clinical Trial Registration: NCT03058081 at clinicaltrials.gov.
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http://dx.doi.org/10.1111/resp.13664DOI Listing
November 2019

Mortality in patients with high risk Staphylococcus aureus bacteremia undergoing or not PET-CT: A single center experience.

J Infect Chemother 2019 Nov 16;25(11):880-885. Epub 2019 May 16.

Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200, Brussels, Belgium.

Background: Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. Previous studies had shown that PET/CT can be helpfull in the management of SAB, leading to reduction of mortality. Factors associated with increased or reduced mortality are not well known. Our objective was to analyze mortality in high risk SAB patients undergoing PET/CT and to identify factors associated with mortality rate.

Materials And Methods: We performed a retrospective study and reviewed all cases of high risk adult SAB between 2014 and 2017. We analyzed medical records and mortality at 30 days and 90 days and 1 year.

Results: A total of 102 patients were included in whom 48 undergone PET/CT. Metastatic foci was identified in 45.8% of cases (22/48). The overall mortality rate was 31.4% (32/102). The mortality rate was 16.6% (8/48) and 44.4% (24/54) in patients undergoing or not PET/CT respectively (P = 0.002). There was a signicantly difference in mortality rate at 30 days (P = 0.001), 90 days (P = 0.004) and one at 1 year (P = 0.002) between patients undergoing or not PET/CT respectively. In multivariate analysis only 18-FDGPET/CT, kidney failure and bacteremia of unknown origin were the 3 mains factors modifying mortality in patients with high risk SAB.

Conclusion: In our study mortality rate was reduced in high risk SAB patients undergoing PET/CT. kidney failure and bacteremia of unknown origin were other factors associtated with high mortality. Our study confirm that PET/CT is a usefull tool in the management of SAB.
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http://dx.doi.org/10.1016/j.jiac.2019.04.016DOI Listing
November 2019

Nasal High-Flow Nebulization for Lung Drug Delivery: Theoretical, Experimental, and Clinical Application.

J Aerosol Med Pulm Drug Deliv 2019 12 14;32(6):341-351. Epub 2019 May 14.

Centre d'études des pathologies respiratoires, INSERM U1100, Faculté de médecine, Université de Tours, Tours, France.

The use of nasal high-flow (NHF) therapy is rapidly spreading across acute care facilities. This raises the question of optimal delivery of inhaled medication to patients undergoing this noninvasive ventilatory support consisting in delivering heated and humidified high gas flow rates through nasal cannulas. In this article, we review experimental and clinical work evaluating the delivery of inhaled medication within the NHF circuit to target the lung without interrupting the ventilatory support. Using vibrating mesh nebulizers placed immediately upstream or downstream of the humidification chamber, with flow rates of 30-45 L/min in adults and 2-6 L/min in children and infants, about 1%-10% of the drug charged in the nebulizer may be delivered to the lungs. Compared with conventional facemask aerosol interfaces, this amount is significantly lower than amounts delivered to adults (i.e., up to 25% of the nominal dose), but similar to amounts delivered to children and infants, the latter having a predominantly nasal breathing. However, significant clinical effects have been shown in both populations when delivering bronchodilators through NHF. This interface is particularly well tolerated and may be useful to improve aerosol therapy tolerance in the pediatric setting. Thus, among patients undergoing NHF therapy, bronchodilators may be delivered through this route. Whereas other drugs may be delivered this way or if there is a patient-centered benefit to specifically use NHF for aerosol therapy among patients without ongoing ventilatory support, requires further evaluation and technological development.
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http://dx.doi.org/10.1089/jamp.2019.1524DOI Listing
December 2019

The Double-Trunk Mask Improves Oxygenation During High-Flow Nasal Cannula Therapy for Acute Hypoxemic Respiratory Failure.

Respir Care 2019 Aug 30;64(8):908-914. Epub 2019 Apr 30.

Institut de Recherche Expérimentale et Clinique (IREC), Pole de Pneumologie, ORL & Dermatologie, Service de Pneumologie, Université Catholique de Louvain, Brussels, Belgium.

Background: High-flow nasal cannula (HFNC) oxygen therapy is used to deliver an F from 0.21 to 1.0. The double-trunk mask (DTM) is a device designed to increase the F in patients with a high inspiratory flow demand. The aim of our study was to evaluate the effect of DTM in hypoxemic subjects already receiving HFNC.

Methods: We report a prospective multi-center crossover pilot study including 15 subjects treated with HFNC for acute hypoxemic respiratory failure. Measurements were performed at the end of 30-min periods with HFNC only, with HFNC + DTM, and again with HFNC only.

Results: Compared with HFNC alone, HFNC + DTM increased P from 68 ± 14 mm Hg to 85 ± 22 mm Hg ( < .001) and did not affect P ( = .18). In the 11 responders, the P increased from 63 ± 12 mm Hg to 88 ± 23 mm Hg ( < .001). No complications were reported during DTM use.

Conclusion: In subjects receiving oxygen via HFNC, the addition of the DTM over the HFNC increased P without changing the P .
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http://dx.doi.org/10.4187/respcare.06520DOI Listing
August 2019

Mechanically-assisted non-invasive ventilation: A step forward to modulate and to improve the reproducibility of breathing-related motion in radiation therapy.

Radiother Oncol 2019 04 25;133:132-139. Epub 2019 Jan 25.

Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium. Electronic address:

Background And Purpose: When using highly conformal radiotherapy techniques, a stabilized breathing pattern could greatly benefit the treatment of mobile tumours. Therefore, we assessed the feasibility of Mechanically-assisted non-invasive ventilation (MANIV) on unsedated volunteers, and its ability to stabilize and modulate the breathing pattern over time.

Materials And Methods: Twelve healthy volunteers underwent 2 sessions of dynamic MRI under 4 ventilation modes: spontaneous breathing (SP), volume-controlled mode (VC) that imposes regular breathing in physiologic conditions, shallow-controlled mode (SH) that intends to lower amplitudes while increasing the breathing rate, and slow-controlled mode (SL) that mimics end-inspiratory breath-holds. The last 3 modes were achieved under respirator without sedation. The motion of the diaphragm was tracked along the breathing cycles on MRI images and expressed in position, breathing amplitude, and breathing period for intra- and inter-session analyses. In addition, end-inspiratory breath-hold duration and position stability were analysed during the SL mode.

Results: MANIV was well-tolerated by all volunteers, without adverse event. The MRI environment led to more discomfort than MANIV itself. Compared to SP, VC and SH modes improved the inter-session reproducibility of the amplitude (by 43% and 47% respectively) and significantly stabilized the intra- and inter-session breathing rate (p < 0.001). Compared to VC, SH mode significantly reduced the intra-session mean amplitude (36%) (p < 0.002), its variability (42%) (p < 0.001), and the intra-session baseline shift (26%) (p < 0.001). The SL mode achieved end-inspiratory plateaus lasting more than 10 s.

Conclusion: MANIV offers exciting perspectives for motion management. It improves its intra- and inter-session reproducibility and should facilitate respiratory tracking, gating or margin techniques for both photon and proton treatments.
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http://dx.doi.org/10.1016/j.radonc.2018.12.026DOI Listing
April 2019