Abstract Background:Proportional assist ventilation (PAV) is a physiological ventilation mode with better patient ventilator synchrony. However its role in intubated patients with chronic obstructive pulmonary disease (COPD) is still not well defined. Objective:To evaluate the efficacy of PAV mode in intubated patients with COPD exacerbation in comparison with conventional synchronized intermittent mandatory ventilation (SIMV) mode. Patients & methods:Fifty COPD patients presented with hypercapnic respiratory failure who are intubated and ventilated were recruited to the study. After 12 h of assist-control ventilation, 25 patients shifted to SIMV mode (group 1) while the other 25 patients shifted to PAV mode (group 2). Vital signs, gasometric and mechanical parameters, duration of ventilation and intensive care unit (ICU) stay were measured. Results:The successful outcome was achieved in 76.0% in group 1 versus 72.0% in group 2. Significant improvement in vital signs, gasometric and mechanical parameters was observed in all patients. Comparison between the two groups after 24 h of ventilation showed significantly higher values in the PAV group for respiratory rate, heart rate, and systolic blood pressure (P 0.001). Significantly lower pH (P 0.01), higher partial arterial carbon dioxide pressure (PaCO2 ) (P 0.001), significantly lower tidal volume, peak inspiratory pressure, auto-positive end expira-tory pressure (auto-PEEP), missing efforts, inspiratory time over total time (Ti/Ttot), shorter duration of ventilation and ICU stay were observed in the PAV group (P 0.01 for each).

Abstract Background:Proportional assist ventilation (PAV) is a physiological ventilation mode with better patient ventilator synchrony. However its role in intubated patients with chronic obstructive pulmonary disease (COPD) is still not well defined. Objective:To evaluate the efficacy of PAV mode in intubated patients with COPD exacerbation in comparison with conventional synchronized intermittent mandatory ventilation (SIMV) mode. Patients & methods:Fifty COPD patients presented with hypercapnic respiratory failure who are intubated and ventilated were recruited to the study. After 12 h of assist-control ventilation, 25 patients shifted to SIMV mode (group 1) while the other 25 patients shifted to PAV mode (group 2). Vital signs, gasometric and mechanical parameters, duration of ventilation and intensive care unit (ICU) stay were measured. Results:The successful outcome was achieved in 76.0% in group 1 versus 72.0% in group 2. Significant improvement in vital signs, gasometric and mechanical parameters was observed in all patients. Comparison between the two groups after 24 h of ventilation showed significantly higher values in the PAV group for respiratory rate, heart rate, and systolic blood pressure (P 0.001). Significantly lower pH (P 0.01), higher partial arterial carbon dioxide pressure (PaCO2 ) (P 0.001), significantly lower tidal volume, peak inspiratory pressure, auto-positive end expira-tory pressure (auto-PEEP), missing efforts, inspiratory time over total time (Ti/Ttot), shorter duration of ventilation and ICU stay were observed in the PAV group (P 0.01 for each).

Abstract Background:Diabetes mellitus is a leading cause of morbidity and mortality among children across the world and is responsible for a growing proportion of global healthcare expenditure. However, limited data are available on lung dysfunction in children with diabetes. Aim:The aim of this study was to evaluate the pulmonary function changes in children with type 1 diabetes mellitus (T1DM). Methods:We studied 60 children with T1DM (mean age 10.5 ± 2.32 years; disease duration 2.45 ± 0.6 years, and 50 healthy control children (mean age 9.9 ± 2.5 years). Spirometry was performed for all individuals to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Glycemic control was assessed on the basis of glycated hemoglobin (HbA1c), with HbA1c values 8% considered to indicate good glycemic control, and HbA1c values ⩾8% to indicate poor control. Results:There was significant reduction in all spirometeric parameters in diabetic children in comparison with healthy control children. Children with poor glycemic control had significant impairment in lung functions compared with those with good glycemic control. Conclusions:T1DM in children leads to impairment of lung functions and this impairment increases with poor glycemic control.

Abstract Background:Diabetes mellitus is a leading cause of morbidity and mortality among children across the world and is responsible for a growing proportion of global healthcare expenditure. However, limited data are available on lung dysfunction in children with diabetes. Aim:The aim of this study was to evaluate the pulmonary function changes in children with type 1 diabetes mellitus (T1DM). Methods:We studied 60 children with T1DM (mean age 10.5 ± 2.32 years; disease duration 2.45 ± 0.6 years, and 50 healthy control children (mean age 9.9 ± 2.5 years). Spirometry was performed for all individuals to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Glycemic control was assessed on the basis of glycated hemoglobin (HbA1c), with HbA1c values 8% considered to indicate good glycemic control, and HbA1c values ⩾8% to indicate poor control. Results:There was significant reduction in all spirometeric parameters in diabetic children in comparison with healthy control children. Children with poor glycemic control had significant impairment in lung functions compared with those with good glycemic control. Conclusions:T1DM in children leads to impairment of lung functions and this impairment increases with poor glycemic control.

Background Idiopathic pulmonary fibrosis (IPF) is the most common and severe form of pulmonary fibrosis characterized by gradual loss of pulmonary function. Despite rigorous research, the etiology of IPF has remained unknown. Viruses, for example, hepatitis C virus (HCV), had been implicated in IPF etiology; however, data on the prevalence of HCV infection in IPF patients were limited. Aim of the study Our aims were to assess the prevalence of HCV antibodies in IPF patients and to assess the relationship between severity of pulmonary and hepatic dysfunction. Materials and methods IPF patients were prospectively enrolled from Chest Department, Assiut University Hospital. HCV antibodies were detected using the third-generation enzyme-linked immunosorbent assay. Patients’ pulmonary and hepatic functions were evaluated. Results HCV antibodies were significantly higher in IPF patients than in controls (29.4 vs. 14%, P= 0.04). Patients with HCV had significantly more severe hypoxemia and lower diffusing capacity for carbon monoxide than those without HCV (47.7 ± 11.3 vs. 54 ± 18.7, P= 0.03 and 52.7 ± 8.4 vs. 67.3 ± 9.5, P= 0.01, respectively). There was no significant difference between HCV-positive IPF patients and HCV-negative IPF patients regarding spirometric parameters and liver function parameters. Conclusion This higher prevalence of HCV and its effect on pulmonary functions in IPF patients may contribute in IPF pathogenesis, which hopefully will allow currently available antiviral drugs or novel therapeutic approaches to treat or modify the course of this devastating disease.

Abstract Background:Anxiety and depression are mental health problems that result in reduced health-related quality of life (HRQL), and increased mortality. Patients with COPD have a higher risk of anxiety and depression compared to healthy individuals. Recent studies reported a signifi-cant relationship between the presence of anxiety and depression and the functional status of COPD patients. Objectives:To study the effect of treatment of anxiety and depression on the physiological status in COPD patients. Materials and methods:The study included 50 severe COPD patients with depression and/or anxiety as evaluated and scored by Montgomery and Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating (HAM-A) Scale. They were classified into 2 groups: group I included 25 patients who received antidepressant/anxiolytic therapy in addition to COPD treatment and group II included 25 patients who received COPD treatment only. Modified Borg scale dyspnea score, spirometry (vital capacity, forced vital capacity, forced expiratory volume in first second and forced expiratory flow through 25–75% of expiration), arterial blood, MADRS and HAM-A scale were assessed in all patients at the start of the study and after 3 months. Results:Patients with severe COPD who were treated for depression and/or anxiety showed a significant improvement in MADRS, HAM-A and dyspnea scales, spirometeric parameters and oxygenation. MADRS and HAM-A scale showed a significant negative correlation to FEV1.Conclusion:Treatment of depression and anxiety in COPD patients is recommended as it is associated with a significant improvement in pulmonary physiological status and HRQL. Further studies on larger scales are recommended.

Background: Cardiovascular dysfunction has been reported as an important mechanism of weaning fail-ure. Brain natriuretic peptide (BNP) is a sensitive and specific marker for cardiovascular dysfunction. Objective: To determine the value of BNP levels measured at initiation and end of a 2 h spontaneous breathing trial (SBT) as a predictor of successful weaning of mechanical ventilation in patients with respiratory illness. Patients and methods: Thirty consecutive patients ready for weaning were prospectively enrolled in this cross-sectional analytic study over a 6-month period. All patients had been on spontaneous mode of weaning for at least 2 h. Tidal volume, respiratory rate, rapid shallow breathing index (RSBI), minute ventilation and PaO2/FiO2were observed at initiation of SBT. BNP was measured at the initiation (BNP1) and at the end of SBT (BNP2). Weaning failure is defined as either the failure of SBT or the need for reintubation within 48 h following extubation. Results: Out of the 30 included patients, 14 (46.6%) patients had failed weaning. PaCO2and BNP2 were significantly higher in the patients with failed weaning as compared to those with successful weaning (P = 0.025, P = 0.031 respectively). However, BNP1 levels were not statistically significant between the 2 groups (P = 0.722). On multiple regression analysis, BNP% (percent change in the BNP level during the 2-h SBT) was the only predictor of weaning success. As compared to other weaning parameters, BNP% ≤ 14.9 had the best sensitivity, specificity, positive and negative predictive value. Conclusion: Measuring the percentage change in the BNP level during a SBT may be a good predictor of weaning success from mechanical ventilation in respiratory patients.

Background: Cardiovascular dysfunction has been reported as an important mechanism of weaning fail-ure. Brain natriuretic peptide (BNP) is a sensitive and specific marker for cardiovascular dysfunction. Objective: To determine the value of BNP levels measured at initiation and end of a 2 h spontaneous breathing trial (SBT) as a predictor of successful weaning of mechanical ventilation in patients with respiratory illness. Patients and methods: Thirty consecutive patients ready for weaning were prospectively enrolled in this cross-sectional analytic study over a 6-month period. All patients had been on spontaneous mode of weaning for at least 2 h. Tidal volume, respiratory rate, rapid shallow breathing index (RSBI), minute ventilation and PaO2/FiO2were observed at initiation of SBT. BNP was measured at the initiation (BNP1) and at the end of SBT (BNP2). Weaning failure is defined as either the failure of SBT or the need for reintubation within 48 h following extubation. Results: Out of the 30 included patients, 14 (46.6%) patients had failed weaning. PaCO2and BNP2 were significantly higher in the patients with failed weaning as compared to those with successful weaning (P = 0.025, P = 0.031 respectively). However, BNP1 levels were not statistically significant between the 2 groups (P = 0.722). On multiple regression analysis, BNP% (percent change in the BNP level during the 2-h SBT) was the only predictor of weaning success. As compared to other weaning parameters, BNP% ≤ 14.9 had the best sensitivity, specificity, positive and negative predictive value. Conclusion: Measuring the percentage change in the BNP level during a SBT may be a good predictor of weaning success from mechanical ventilation in respiratory patients.

Abstract: OBJECTIVE:This prospective study was conducted to evaluate the value of sonographic B-lines (previously called ‘‘comet tail artifacts’’), which are long, vertical, well-defined, hyperechoic, dynamic lines originating from the pleural line in assessment of interstitial lung diseases (ILD) and compare them with the findings of chest high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs). MATERIALS AND METHODS:Sixty-one patients with ILD underwent transthoracic lung ultrasound for assessment of the presence of B-lines and the distance between them. These findings were compared with that of chest HRCT (ground glass, reticular, nodular or honey combing) and PFT as forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity for carbon monoxide (DLCO) and partial arterial oxygen pressure (PaO 2 ). RESULTS:All patients had diffuse bilateral B-lines. The distance between each of the two adjacent B lines correlated with the severity of the disease on chest HRCT where B3 (the distance was 3 mm) correlated with ground glass opacity and B7 (the distance was 7 mm) correlated with extensive fibrosis and honey combing. Also, the distance between B-lines inversely correlated with FVC (r =−0.848, P 0.001), TLC (r =−0.664, P 0.001), DLCO (r =−0.817, P 0.001) and PaO 2 (r =−0.902, P 0.001). CONCLUSION:B-lines that are lung Ultrasound signs seem to be useful in the assessment of ILD.

Abstract: OBJECTIVE:This prospective study was conducted to evaluate the value of sonographic B-lines (previously called ‘‘comet tail artifacts’’), which are long, vertical, well-defined, hyperechoic, dynamic lines originating from the pleural line in assessment of interstitial lung diseases (ILD) and compare them with the findings of chest high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs). MATERIALS AND METHODS:Sixty-one patients with ILD underwent transthoracic lung ultrasound for assessment of the presence of B-lines and the distance between them. These findings were compared with that of chest HRCT (ground glass, reticular, nodular or honey combing) and PFT as forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity for carbon monoxide (DLCO) and partial arterial oxygen pressure (PaO 2 ). RESULTS:All patients had diffuse bilateral B-lines. The distance between each of the two adjacent B lines correlated with the severity of the disease on chest HRCT where B3 (the distance was 3 mm) correlated with ground glass opacity and B7 (the distance was 7 mm) correlated with extensive fibrosis and honey combing. Also, the distance between B-lines inversely correlated with FVC (r =−0.848, P 0.001), TLC (r =−0.664, P 0.001), DLCO (r =−0.817, P 0.001) and PaO 2 (r =−0.902, P 0.001). CONCLUSION:B-lines that are lung Ultrasound signs seem to be useful in the assessment of ILD.