Pneumologie最新文献

{"title":"[Role of red blood cell (RBC) transfusions in patients with prolonged mechanical ventilation during weaning process].","authors":"Henry Schäfer, Jan Edel, Carlos Martinez, Christopher Wallenhorst, Alfred Hellstern","doi":"10.1055/a-2368-3815","DOIUrl":"10.1055/a-2368-3815","url":null,"abstract":"<p><strong>Aim: </strong>Patients undergoing long-term ventilation often show anemia. The aim of the study was to investigate the duration and success of weaning from mechanical ventilation in patients with RBC transfusion.</p><p><strong>Methods: </strong>A retrospective analysis of patient data from a weaning unit was performed. Transfused and non-transfused patients were matched using a propensity score. Of the 249 patients in the database, 31 transfused and the same number of non-transfused cases with similar disease severity as measured by the Simplified Acute Physiology Score (SAPS) could be analyzed. Additional sensitivity analyses were performed.</p><p><strong>Results: </strong>In the group of transfused patients, the difference in weaning duration was longer than in non-transfused patients (1.35 days and 3.26 days, respectively). Weaning success also varied. The risk of weaning failure was twice as high in the group of transfused patients. The groups also differed in terms of mortality, 25.8% of the transfused patients died, while in the non-transfused patients the mortality rate was 6.5%. The risk of death was increased in patients who received RBC transfusion. The differences were not statistically significant.</p><p><strong>Conclusion: </strong>A high proportion of patients with prolonged mechanical ventilation have anemia. RBC transfusion does not improve their prognosis. The need for transfusion is associated with higher mortality and longer duration of weaning in this population. The indication for RBC transfusion should therefore be restrictive.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"123-133"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexamethasone, Remdesivir and Azithromycin modulate ACE2 and IL-6 in Lung Epithelial Cells.","authors":"Gudrun Sigrid Ulrich-Merzenich, Anastasiia Shcherbakova, Carmen Pizarro, Dirk Skowasch","doi":"10.1055/a-2372-3632","DOIUrl":"10.1055/a-2372-3632","url":null,"abstract":"<p><strong>Background: </strong>The optimal use of steroids in COVID-19 patients remains challenging. Current S3-guidelines \"Recommendations for patients with COVID-19\" recommend dexamethasone (DEX) for patients requiring respiratory support, remdesivir (RD) in the early disease phase and azythromycin (AZ) is no longer recommended. We investigated effects of DEX, RD and AZ in a lipopolysaccharide induced inflammation in lung cells in vitro and analyzed publicly available datasets with a focus on the Angiotensin-converting enzyme 2 (ACE2) to better understand drugs' mechanisms of action.</p><p><strong>Methods: </strong>human bronchial (Calu) and alveolar (A549) lung epithelial cells were treated with DEX, AZ or RDV in the presence of lipopolysaccharides (LPS). Gene expression (GE) of ACE2, IL-6 and the IL-6 protein release were measured. Publicly available GE data from lung tissues of COVID-19 patients and from lung cells treated with DEX were analyzed for the GE of ACE2.</p><p><strong>Results: </strong>DEX increased and RDV and AZ reduced the GE of ACE2 in LPS-stimulated bronchial and alveolar epithelial cells. Only DEX significantly reduced LPS-induced IL-6 releases in alveolar cells substantially. The database analyses showed an, albeit not always significant, increase in ACE2 for lung tissue or cell lines treated with DEX. Lung tissue from patients after COVID-19 infection as well as bronchial cell cultures after COVID-19 infection showed lower GEs of ACE2.</p><p><strong>Discussion and conclusion: </strong>DEX can increase ACE2 expression in vitro and thereby the portal of entry of SARS-CoV-2 into lung cells during an LPS induced inflammation. Simultaneously the inflammatory marker IL-6 is reduced. Comparative database analyses indicate that these processes can also take place in vivo.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"134-140"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Recommendations for training courses in bronchoscopy - update 2024].","authors":"Lars Hagmeyer, Ralf-Harto Hübner, Kaid Darwiche, Ralf Eberhardt, Andreas Gebhardt, Felix Herth, Angelique Holland, Joanna Krist, Carmen Pizarro, Gregor Zimmermann, Manfred Wagner","doi":"10.1055/a-2493-5802","DOIUrl":"10.1055/a-2493-5802","url":null,"abstract":"<p><p>Bronchoscopy courses should be an integral part of bronchoscopy training. Course graduates should be familiar with the indications, prerequisites and technical possibilities of bronchoscopy. In addition to theoretical content, practical bronchoscopic skills are taught and trained in small supervised groups using various methods of simulation-based bronchoscopy training. The course content is based on the current guidelines and recommendations of the DGP as well as the applicable national directives and KRINKO recommendations. The standardization of central course elements serves to ensure quality assurance across the board, whilst explicitly supporting local site-specific focuses and preferences.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"119-122"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Meaning and Mechanisms of Birdsong: Inspiration for Pneumology].","authors":"Bernd Schönhofer, Manfred Gahr","doi":"10.1055/a-2463-7380","DOIUrl":"https://doi.org/10.1055/a-2463-7380","url":null,"abstract":"<p><p>In contrast to humans, the location where sound is produced in birds is not the larynx, but rather the so-called \"vocal box\" (scientific term \"Syrinx\"). In some species the syrinx is located at the bifurcation point of the trachea into the two main bronchi (tracheal vocal head), while in some in the main bronchi (bronchial vocal head). During inspiration, part of the air flows into the lungs, and the part needed for singing flows into the air sacs adjacent to the lungs. During expiration, air leaves the air sacs and flows through the syrinx, where the song is created. When birds sing in two voices at the same time, individual sequences are formed simultaneously in the right and left parts of the syrinx.The song analysis is based on spectrograms (so-called sonagrams), which graphically represent the frequency spectrum of bird song.The song consists of one or more verses, which in turn consist of the variable or constant sequence of motives or syllables. Some songbirds have an enormous repertoire of syllables and verses (max. up to 7000 verses per day). In addition to singing, most bird species also have much simpler begging, contact, threatening, flight, alarm and copulation calls.Male birds sing primarily for two reasons: 1. They use song to woo a potential partner. This song provides the females with important information about the applicant's performance and health. 2. Singing serves to defend the territory.In around 40 % of songbird species, females also sing. Pairs of some species sing in perfect synchronization.A number of songbirds imitate both the voices of other songbirds and ambient noises, and many songbirds have regional dialects.Song development depends on genetics and other factors such as the environment, metabolism and hormonal influences. It proceeds step by step and initially includes relatively primitive sequences (so-called \"subsongs\"), then leads through more complex intermediate forms (\"plastic songs\") and finally to the completed singing pattern (\"full songs\").Young birds learn the song of their species at a time when they are not yet singing themselves, often as nestlings aged 10 to 50 days from older members of the species, usually from their fathers.The song of young birds develops, based on the template of adult song, in a network of sensory-motor neurons in the forebrain.Songbirds, especially the zebra finch, currently offer the best model for the neural basis of human language learning. In birds, the so-called \"High Vocal Center\" orchestrates all brain regions relevant to songs, with the neural control of song being sensitive to sex hormones.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interest-driven framing: the language of the nicotine industry].","authors":"Waltraud Posch, Sabina Ulbricht, Reiner Hanewinkel","doi":"10.1055/a-2508-1456","DOIUrl":"https://doi.org/10.1055/a-2508-1456","url":null,"abstract":"<p><p>The consumption of conventional tobacco products has been declining for years. As a result, the tobacco and nicotine industry has opened up new markets and now has a range of different nicotine products in its portfolio. The aim of the present study was to show how the nicotine industry uses language to create awareness and characterize new nicotine products as supposedly less risky than traditional tobacco products.Key terms introduced by the tobacco and nicotine industry are identified as exemplifying the interest-driven linguistic framing of new nicotine products.Terms introduced by the tobacco and nicotine industry such as \"reduced-risk\", \"smoke- and tobacco-free\", \"vaping\", \"alternative products\" can be understood as a targeted marketing strategy that trivializes the risks associated with the use of e-cigarettes, tobacco heaters and other products.The tobacco and nicotine industry has managed to establish a friendly and reassuring terminology for the newly introduced nicotine products. It is a major challenge to replace these terms with a nomenclature that adequately describes the health risks, in particular the risk of addiction and health hazards of consuming these nicotine products. Appropriate proposals will be made.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Comorbidity of Lung Cancer and ILD: A Review.","authors":"Mark Uhlenbruch, Markus Polke, Damian von Eiff, Aris Koryllos, Stefan Krüger","doi":"10.1055/a-2512-8349","DOIUrl":"https://doi.org/10.1055/a-2512-8349","url":null,"abstract":"<p><p>Patients with interstitial lung disease (ILD) and especially with idiopathic pulmonary fibrosis(IPF) suffer from reduced survival expectation and risk of exacerbations. Lung cancer is a relevant comorbidity in ILD patients and associated with impaired survival.The most frequent ILD among patients with NSCLC (Non-small cell lung cancer) is idiopathic pulmonary fibrosis (IPF), which is associated with an greater decline in lung function and a higher risk of death.The prevalence of lung cancer in patients with ILD is up to 10% and in autopsy studies a prevalence up to 48% has been found.There are no guidelines for patients with lung cancer and ILD. Moreover, no adequate evidence is available.Therefore, we reviewed currently available literature to present an overview of the state of the art.In this review we focus on staging and treatment of the comorbidity of lung cancer and ILD.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Improving Specialist Care for Patients in Out-of-Hospital Intensive Care through Regular Pulmonological Video Consultations: A Real-life Study].","authors":"Claudia Jafari, Nilüfer Orhan, Sören Hammermüller, Gernoth Plappert, Stephan Porten, Alan Strassburg","doi":"10.1055/a-2493-8311","DOIUrl":"https://doi.org/10.1055/a-2493-8311","url":null,"abstract":"<p><strong>Background: </strong>In recent years, there has been a significant increase in the number of patients requiring out-of-hospital intensive care. Although many of these patients are invasively ventilated, pulmonological care is often lacking. Additionally, up to 60-70% of these patients are suspected to have further potential for weaning. A telemedicine approach to assess weaning potential and provide pulmonological care has not yet been studied.</p><p><strong>Methods: </strong>From March 2021 to February 2024, we conducted telemedicine pulmonological consultations in four respiratory care groups. A medical history interview and the assessment of parameters such as ventilation measurements were performed via a video portal. In addition, a portable blood gas analysis (BGA) device and a digital stethoscope were used. Treatment recommendations were implemented by the primary care physicians. These data were compared with a control group from four respiratory care groups that did not receive pulmonological care.</p><p><strong>Results: </strong>A total of 71 tracheotomized patients, regardless of their weaning potential, were included in the telemedicine group. Of these, 40 were breathing spontaneously and 31 were mechanically ventilated (weaning stages 3aII and 3cI respectively). The ventilation duration of 23/31 (74%) patients in the telemedicine group was successfully reduced: 5/31 (16%) required only nocturnal ventilation, and in 4/31 (13%), ventilation was completely discontinued. In a control group of 63 patients (3aII: n=34, 3cI: n=29), only 1/29 (3%) experienced a reduction in ventilation time.In the telemedicine group, 11/71 (15%) patients were admitted for decannulation (3aII: n=6, 3cI: n=5). Of these, 7/11 (64%) were successfully decannulated (3aII: n=3, 3cI: n=4), with an average hospital stay reduced to 9 days. In the control group, 3/63 (5%) patients were admitted for decannulation, but none were successfully decannulated. One patient was successfully decannulated during a hospital stay for another reason.In addition, 310 tele-pulmonological therapy modifications were made in the intervention group, corresponding to 978 patient months: 1/3 patients required a therapy modification per month.</p><p><strong>Conclusion: </strong>Tele-pulmonological care in out-of-hospital intensive care allows for the identification of weaning potential, the targeted planning of hospital stays for weaning, and the avoidance of unnecessary hospitalizations. Moreover, it improves patient treatment outcomes. Regular monitoring at individualized intervals is necessary for this approach.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Use of adjuvant treatment options in tobacco and nicotine counseling: results of an anonymous survey].","authors":"Sabina Ulbricht, Christa Rustler, Karin Vitzthum","doi":"10.1055/a-2507-1425","DOIUrl":"https://doi.org/10.1055/a-2507-1425","url":null,"abstract":"<p><p>Counseling and treatment of tobacco and nicotine users include classical behavioral therapy and cognitive-behavioral therapy methods. More than half of the quitters after an intervention relapsed into old behavior after 12 months. Discussions with experts have shown that evidence-based interventions are individually supplemented with treatment options without scientific evidence or with inconsistent efficacy. This study examined the use of adjuvant treatment options in the area of smoking cessation such as aromatherapy.The sample for our anonymous online survey (Sosci survey) consisted of 351 experts. All of them had registered with their contact data in a freely accessible database (https://www.anbieter-raucherberatung.de/anbieter.php). A total of 88 experts took part in the survey. Respondents were on average 53 years old, and 71% were female. They reported on average 14 years of experience in smoking cessation counseling. More than half of the participants (66.3%; n=57) had employed at least one adjuvant treatment option. Exercise (49.1%), hypnosis (34.5%) and acupuncture (27.3%) were mentioned most often.Adjuvant treatment options appear to be important in the counseling of tobacco and nicotine users and there should be more discussion on these options among experts. These should also considered in the development of curricula for counsellors on tobacco and nicotine cessation.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[S3 Guideline: Treating Chronic Respiratory Failure with Non-invasive Ventilation].","authors":"Sarah Bettina Stanzel, Jens Spiesshoefer, Franziska Trudzinski, Christian Cornelissen, Hans-Joachim Kabitz, Hans Fuchs, Matthias Boentert, Tim Mathes, Andrej Michalsen, Sven Hirschfeld, Michael Dreher, Wolfram Windisch, Stephan Walterspacher","doi":"10.1055/a-2347-6539","DOIUrl":"10.1055/a-2347-6539","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"25-79"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prolonged weaning after long-term ventilation due to SARS-CoV-2 infection: a multicenter retrospective analysis].","authors":"Florian Geismann, Lucas Braunschmidt, Arno Mohr, Thorsten Hardebusch, Michael Westhoff, Michael Dreher, Tobias Müller, Alexander Heine, Hemendra Ramdatt, Anne Obst, Ralf Ewert","doi":"10.1055/a-2370-1763","DOIUrl":"10.1055/a-2370-1763","url":null,"abstract":"<p><p>Some of the patients with SARS-CoV-2 infection (COVID-19) received invasive ventilation during inpatient care. Weaning from ventilation was difficult for some patients (so-called prolonged weaning).</p><p><strong>Patients: </strong>Patients (n=751) with prolonged weaning (reason for ventilation \"pneumonia\" and \"acute respiratory failure\") from four centers for the period 2011-23 from the \"WeanNet\" registry were used as a matched group.</p><p><strong>Results: </strong>The median duration of intensive medical care was 39 (25-68) days. In 19% (37/193) of patients, ECMO support was necessary for a median of 27 (18-51) days. In-hospital mortality was 8.3% (2.7% with vs. 9.6% without ECMO) and 6.8% died in the comparison group. At discharge, 84% (vs. 77% in the control group) were completely weaned and 2.6% (vs. 17.6% in the control group) of patients received non-invasive treatment. Invasive ventilation was still necessary in 7.8% (control group 15.7%). In the observation period of 6 months after discharge, 22.4% of patients required inpatient care and a further 14.1% after 12 months. The overall mortality at 12-month follow-up was 20,6% (5.6% with vs. 24.6% without ECMO).</p><p><strong>Discussion: </strong>The mortality rate of ventilated patients with COVID-19 was very low at 8.3% in the four weaning centers studied. The mortality rate of patients with ECMO treatment was only 2.7%. The mortality rate in the control group was 7.3%. The lower mortality of patients with ECMO treatment was also evident at follow-up of up to 12 months.Patients with prolonged weaning who received invasive ventilation due to COVID-19 showed comparable results in terms of successful weaning and mortality compared to a control group from the WeanNet registry. The long-term results with a survival of more than 80% for the first year after discharge were encouraging.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"80-86"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}