January 2025
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4 Reads
Revue des Maladies Respiratoires Actualités
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Publications (32)
January 2025
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9 Reads
Revue des Maladies Respiratoires Actualités
June 2024
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25 Reads
Background: Thoraco-abdominal asynchrony (TAA) is usually assessed by respiratory inductance plethysmography. The main parameter used for its assessment is the calculation of the phase angle based on Lissajous plots. However, there are some mathematical limitations to its use. Research design and methods: Sequences of five breaths were selected from a) normal subjects, b) COPD patients, both at rest and during exercise, and c) patients with obstructive apnea syndrome. Automated analysis was performed calculating phase angle, loop rotation (clockwise or counterclockwise), global phase delay and loop area. TAA severity was estimated quantitatively and in subgroups. Results: 2290 cycles were analyzed (55% clockwise rotation). Phase angle ranged from -86.90 to + 88.4 degrees, while global phase delay ranged from -179.75 to + 178.54. Despite a good correlation with global phase delay (p < 0.01, ANOVA test), phase angle and loop area were not able to correctly classify breaths with severe deviation and paradoxical movements (p=ns, Bonferroni post hoc test). Conclusions: Global phase delay covers the whole spectrum of TAA situations in a single value. It may be a relevant parameter for diagnosis and follow-up of clinical conditions leading to TAA. Clinical trial registration: The trial from which the traces were obtained was registered at ClinicalTrials.gov ;(identifier: NCT04597606).
February 2024
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34 Reads
Pulmonology
January 2024
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13 Reads
Revue des Maladies Respiratoires Actualités
February 2023
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209 Reads
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96 Citations
Cancer Discovery
Immune-checkpoint-inhibitor (ICI)–associated myotoxicity involves the heart (myocarditis) and skeletal muscles (myositis), which frequently occur concurrently and are highly fatal. We report the results of a strategy that included identification of individuals with severe ICI myocarditis by also screening for and managing concomitant respiratory muscle involvement with mechanical ventilation, as well as treatment with the CTLA4 fusion protein abatacept and the JAK inhibitor ruxolitinib. Forty cases with definite ICI myocarditis were included with pathologic confirmation of concomitant myositis in the majority of patients. In the first 10 patients, using recommended guidelines, myotoxicity-related fatality occurred in 60%, consistent with historical controls. In the subsequent 30 cases, we instituted systematic screening for respiratory muscle involvement coupled with active ventilation and treatment using ruxolitinib and abatacept. The abatacept dose was adjusted using CD86 receptor occupancy on circulating monocytes. The myotoxicity-related fatality rate was 3.4% (1/30) in these 30 patients versus 60% in the first quartile (P < 0.0001). These clinical results are hypothesis-generating and need further evaluation. Significance Early management of respiratory muscle failure using mechanical ventilation and high-dose abatacept with CD86 receptor occupancy monitoring combined with ruxolitinib may be promising to mitigate high fatality rates in severe ICI myocarditis.
June 2021
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97 Reads
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1 Citation
Respirology
May 2020
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156 Reads
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146 Citations
European Respiratory Journal
February 2020
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235 Reads
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38 Citations
Respirology
Background and objective: Average volume-assured pressure support-automated expiratory positive airway pressure (AVAPS-AE) combines an automated positive expiratory pressure to maintain upper airway patency to an automated pressure support with a targeted tidal volume. The aim of this study was to compare the effects of 2-month AVAPS-AE ventilation versus pressure support (ST) ventilation on objective sleep quality in stable patients with OHS. Secondary outcomes included arterial blood gases, health-related quality of life, daytime sleepiness, subjective sleep quality and compliance to NIV. Methods: This is a prospective multicentric randomized controlled trial. Consecutive OHS patients included had daytime Pa CO2 > 6 kPa, BMI ≥ 30 kg/m2 , clinical stability for more than 2 weeks and were naive from home NIV. PSG were analysed centrally by two independent experts. Primary endpoint was sleep quality improvement at 2 months. Results: Among 69 trial patients, 60 patients had successful NIV setup. Baseline and follow-up PSG were available for 26 patients randomized in the ST group and 30 in the AVAPS-AE group. At baseline, Pa CO2 was 6.94 ± 0.71 kPa in the ST group and 6.61 ± 0.71 in the AVAPS-AE group (P = 0.032). No significant between-group difference was observed for objective sleep quality indices. Improvement in Pa CO2 was similar between groups with a mean reduction of -0.87 kPa (95% CI: -1.12 to -0.46) in the ST group versus -0.87 kPa (95% CI: -1.14 to -0.50) in the AVAPS-AE group (P = 0.984). Mean NIV use was 6.2 h per night in both groups (P = 0.93). NIV setup duration was shorter in the AVAPS-AE group (P = 0.012). Conclusion: AVAPS-AE and ST ventilation for 2 months had similar impact on sleep quality and gas exchange.
May 2019
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15 Reads
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1 Citation
Citations (13)
... The myotoxicity associated with immune-checkpoint inhibitors (ICIs) affects both the heart (myocarditis) and skeletal muscles (myositis), often occurring simultaneously with a high mortality rate. Salem et al. [108] presented findings from a strategy that involved identifying patients with severe ICI myocarditis by screening for and managing concurrent respiratory muscle involvement via mechanical ventilation, in addition to administering the CTLA4 fusion protein abatacept and the JAK inhibitor ruxolitinib. A total of forty confirmed cases of ICI myocarditis were included, with the majority showing pathological evidence of accompanying myositis. ...
- Citing Article
February 2023
Cancer Discovery
... mettait en évidence que l'analyse automatique de ces courbes permettait de fournir des données fiables sur un spectre plus large d'asynchronies, incluant notamment les auto-et doubles-déclenchements[159].L'analyse automatique des données de ventilation, par des systèmes externes ou par les logiciels intégrés aux appareils de ventilation, représente aujourd'hui un axe de développement technologique important qui, au-delà de réduire la variabilité inter-examinateur concernant l'analyse de ces données[159], ouvre la porte à un ajustement, automatisé lui aussi, des principaux paramètres ventilatoires, en particulier de l'AI et/ou de la PEP. Cette approche, qui ne fait pas aujourd'hui l'unanimité[95,160,161], suscite néanmoins un intérêt croissant[162]. Dans une enquête récemment conduite auprès des membres du groupe VNI de l'ERS, les répondants (n=166) précisaient que chez les patients à profil restrictif (incluant MNM et syndromes restrictifs thoraciques) traités par VNI nocturne exclusivement, les modes barométriques avec volume cible étaient très largement utilisés (29% des répondants)[51].Il apparait évident que, pour que l'ajustement automatique des paramètres ventilatoires soit cliniquement adapté, la qualité du monitorage devra, avant toute chose, être elle-même optimale. ...
- Citing Article
- Full-text available
June 2021
Respirology
... Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a coronavirus strain that caused the coronavirus disease 2019 (COVID-19) pandemic (1,2). ...
- Citing Article
- Full-text available
May 2020
European Respiratory Journal
... There are a small number of studies comparing these devices to standard, fixed-pressure bi-level therapy. Most studies have shown that auto-titrating bi-level therapy is non-inferior to standard therapy [67][68][69][70]. However, these studies are limited by small participant numbers, short follow-up, and the primary outcome measures used. ...
- Citing Article
February 2020
Respirology
... La perturbation du réflexe respiratoire et des centres neuronaux responsables de la régulation de la respiration aggrave l'hypoventilation alvéolaire. Une seule étude s'est penchée sur la survie de patients atteints de SLA admis en réanimation pour une insuffisance respiratoire aiguë [55]. La mortalité en réanimation était de 33 %, et la mortalité à un an de 71 %. ...
- Citing Article
November 2018
Journal of Critical Care
... Recent studies also suggested that OM is the most frequently used interface in long-term NIV, particularly for chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS) even if no difference in efficacy or in tolerance was demonstrated between interfaces when they were compared [5]. Preliminary data from Antadir-GAVO2, a French prospective cohort that currently includes 2052 patients newly treated at home with long-term NIV, showed that OM was the first choice in about 81% of patients, both for NIV in an acute situation (85.7%) and at steady state (78.6%) [8]. ...
- Citing Conference Paper
September 2017
... Hyperinflation resulting from SAD can also contribute to the low FVC of PRISm. Indeed, SAD is known to be prevalent in patients with ischemic heart disease [34]. Likewise, ongoing systemic inflammation, one of the main features of COPD pathobiology related to cardiovascular comorbidities [35], can partly explain this association between PRISm and CAC progression. ...
- Citing Article
- Full-text available
August 2017
... TAA has been studied using various methods. In recent research, non-contact methods such as structured light plethysmography [3], or skin electrode respiratory impedance [4], have been proposed. However, respiratory inductance plethysmography (RIP) remains the most widely used and tested method in the study of TAA [5]. ...
- Citing Article
- Full-text available
May 2017
... In a multicenter study from France, Georges and colleagues found that only 66% of patients with ALS had an MIP performed before NIV initiation. 16 More recent French cohorts investigating early home NIV initiation have also observed impaired MIPs with preserved FVC and normocapnia before early NIV initiation. 17,18 Vitacca and colleagues reported that, in Italy, two thirds of the pulmonary units initiated NIV based on a reduced FVC and only half based on MIP. ...
- Citing Article
December 2016
... Both techniques can be used in young children (Stick et al. 1992;Bates et al. 2000), but practical drawbacks have limited their use clinically. Specifically, the use of a mouthpiece or mask in PNT may cause individuals to alter their normal breathing pattern, while slippage of the transducer bands used in RIP can affect the accuracy of data (Weissman et al. 1984;Stick et al. 1992;Caretti et al. 1994;Laveneziana et al. 2015a). Furthermore, although some studies have reported respiratory disease-related changes in certain tidal breathing parameters, there is no agreement on which parameter(s) should be routinely assessed (Kuratomi et al. 1985;Brack et al. 2002;Schmalisch et al. 2005). ...
- Citing Article
September 2015
European Respiratory Journal