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A Randomised Crossover Trial Comparing Volume Assured and Pressure Preset Noninvasive Ventilation in Stable Hypercapnic COPD.

A Randomised Crossover Trial Comparing Volume Assured and Pressure Preset Noninvasive Ventilation in Stable Hypercapnic COPD.

COPD. 2010 Dec;7(6):398-403

Authors: Oscroft NS, Ali M, Gulati A, Davies MG, Quinnell TG, Shneerson JM, Smith IE

ABSTRACT Recent randomised controlled trials suggest non-invasive ventilation may offer benefit in the long-term management of ventilatory failure in stable COPD. The best mode of ventilation is unknown and newer volume assured modes may offer advantages by optimising ventilation overnight when treatment is delivered. This study compares volume assured with pressure preset non-invasive ventilation. Randomised crossover trial including twenty five subjects previously established on long-term non-invasive ventilation to manage COPD with chronic ventilatory failure. Two 8-week treatment periods of volume assured and pressure preset non-invasive ventilation. The primary outcomes were daytime arterial blood gas tensions and mean nocturnal oxygen saturation. Secondary outcomes included lung function, exercise capacity, mean nocturnal transcutaneous carbon dioxide, health status and compliance. No significant differences were seen in primary or secondary outcomes following 8 weeks of treatment when comparing volume assured and pressure preset ventilation. Primary outcomes assessed: mean (standard deviation) PaO(2) 7.8 (1.2) vs 8.1(1) kPa, PaCO(2) 6.7 (1.1) vs 6.3 (1.2) kPa and mean nocturnal oxygenation 90 (4) vs 91 (3)% volume assured versus pressure preset, respectively. Volume assured and pressure preset non-invasive ventilation appear equally effective in the long-term management of ventilatory failure associated with stable COPD.

PMID: 21166627 [PubMed - in process]

Prospects for a new, safer and more effective TB vaccine.

Prospects for a new, safer and more effective TB vaccine.

Paediatr Respir Rev. 2011 Mar;12(1):46-51

Authors: Hawkridge T, Mahomed H

Tuberculosis in infants and young children remains an all too common cause of morbidity and mortality in high burden countries, despite the fact that the majority of these children receive vaccination with BCG in infancy. BCG confers incomplete and variable protection against pulmonary tuberculosis [PTB] and is unsafe in HIV positive persons. Newer TB vaccines, which, it is hoped, will either replace or complement BCG are being developed and a number of these have reached the stage of clinical trials, with two booster vaccines going into Phase IIB trials in 2009. Prospects for at least one new licensed TB vaccine within the next 5-10 years appear reasonable. This article explores some of the issues around the development of new vaccines against TB and details the leading candidates.

PMID: 21172675 [PubMed - in process]

Novel Developments in the Epidemic of HIV and TB Co-Infection.

Novel Developments in the Epidemic of HIV and TB Co-Infection.

Am J Respir Crit Care Med. 2010 Dec 22;

Authors: Anandaiah A, Dheda K, Keane J, Koziel H, Moore DA, Patel NR

Tuberculosis (TB) disease remains one of the highest causes of mortality in HIV infected individuals, and HIV-TB co-infection continues to grow at alarming rates especially in sub-saharan Africa. Surprisingly, a number of important areas regarding co-infection remain unclear. For example, increased risk of TB disease begins early in the course of HIV infection, however the mechanism of how HIV increases this risk is not well understood. In addition, there is lack of consensus on the optimal way to diagnose latent infection and to manage active disease in the HIV infected. Furthermore, effective point-of care testing for TB disease remains elusive. This review will discuss key areas in the epidemiology, pathogenesis, diagnosis and management of active and latent TB in HIV, providing attention to issues related to high and low burden areas. Particular emphasis will be placed on controversial areas where there are gaps in knowledge and in future directions of needed study.

PMID: 21177884 [PubMed - as supplied by publisher]

Encouraging News for Multidrug-resistant Tuberculosis Treatment.

Authors: Mitnick C, Horsburgh CR PMID: 21123746 [PubMed - in process] (Source: American Journal of Respiratory and Critical Care Medicine)

6-Minute Walk Test in Idiopathic Pulmonary Fibrosis: Test Validation and Minimal Clinically Important Difference.

CONCLUSIONS: The 6MWT is a reliable, valid, and responsive measure of disease status and a valid endpoint for clinical trials in IPF. PMID: 21131468 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

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