Survival prospects of pulmonary arterial hypertension associated with congenital heart disease: Insights from the HOPE registry.

Background: Pulmonary arterial hypertension (PAH) is a severe complication among adult patients with congenital heart disease (ACHD). This study presents real-world data on risk stratification, pharmacotherapy and survival rates in PAH-ACHD.

Methods: Data from PAH-ACHD patients were analyzed using The Hellenic Pulmonary Hypertension Registry (HOPE), spanning eight specialized centers between 2015 and 2023.

Two women with unexplained dyspnoea: removing the blame game from the lungs.

https://bit.ly/4bTP8fJ.

Gastric Pressure Monitoring Unveils Abnormal Patient-Ventilator Interaction Related to Active Expiration: A Retrospective Observational Study.

Background: Patient-ventilator dyssynchrony is frequently observed during assisted mechanical ventilation. However, the effects of expiratory muscle contraction on patient-ventilator interaction are underexplored. The authors hypothesized that active expiration would affect patient-ventilator interaction and they tested their hypothesis in a mixed cohort of invasively ventilated patients with spontaneous breathing activity.

Respiratory drive: a journey from health to disease.

Respiratory drive is defined as the intensity of respiratory centers output during the breath and is primarily affected by cortical and chemical feedback mechanisms. During the involuntary act of breathing, chemical feedback, primarily mediated through CO, is the main determinant of respiratory drive. Respiratory drive travels through neural pathways to respiratory muscles, which execute the breathing process and generate inspiratory flow (inspiratory flow-generation pathway).

Driving pressure of respiratory system and lung stress in mechanically ventilated patients with active breathing.

Background: During control mechanical ventilation (CMV), the driving pressure of the respiratory system (ΔP) serves as a surrogate of transpulmonary driving pressure (ΔP). Expiratory muscle activity that decreases end-expiratory lung volume may impair the validity of ΔP to reflect ΔP. This prospective observational study in patients with acute respiratory distress syndrome (ARDS) ventilated with proportional assist ventilation (PAV+), aimed to investigate: (1) the prevalence of elevated ΔP, (2) the ΔP-ΔP relationship, and (3) whether dynamic transpulmonary pressure (Plung) and effort indices (transdiaphragmatic and respiratory muscle pressure swings) remain within safe limits.

Inspiratory effort and breathing pattern change in response to varying the assist level: A physiological study.

Aim: To describe the response of breathing pattern and inspiratory effort upon changes in assist level and to assesss if changes in respiratory rate may indicate changes in respiratory muscle effort.

Methods: Prospective study of 82 patients ventilated on proportional assist ventilation (PAV+). At three levels of assist (20 %-50 %-80 %), patients' inspiratory effort and breathing pattern were evaluated using a validated prototype monitor.