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Can high flow nasal cannula prevent intubation?
A systematic review and meta-analysis compared conventional care and non-invasive ventilation (NIPPV) with the use high-low nasal cannula (HFNC) in adults with respiratory failure (Monro-Somerville et al. Crit Care Med 2017;45:e449–56). Fourteen trials were included in the systematic review, nine in the meta-analysis (2507 subjects). There was no difference in mortality (HFNC, 60/1006 (6%) vs usual care, 90/1106 (8.1%)) (n=2112; p=0.29; OR, 0.83; 95% CI, 0.58 to 1.17). There was no difference in rate of intubation rate (HFNC, 119/1207 (9.9%) vs usual care, 204/1300 (15.7%)) (n=2507; p=0.08; OR, 0.63; 95% CI, 0.37 to 1.06). There was improved patient comfort and dyspnoea.
What are the long term implications of undiagnosed COPD?
Screening for COPD occurs in previous or current smokers who present with respiratory symptoms. A group from Denmark carried out a prospective cohort study from the Copenhagen General Population Study, to see if there was an increased rate of exacerbations, pneumonia and death, those with undiagnosed COPD (Çolak et al. Lancet Respir Med 2017;5:426–34). A total of 95 288 people between November 2003 and July 2013 were screened. A high risk group (aged over 40, at least 10 pack years of tobacco, no previous history of asthma) …
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