Daniel Langer

Inspiratory muscle weakness is common among mechanically ventilated patients and is a well-recognized contributor to weaning difficulties, which are associated with poor outcomes and increased mortality. Inspiratory muscle training is a feasible and promising intervention that can improve global respiratory muscle strength and potentially facilitate successful liberation from mechanical ventilation in patients with weaning difficulties. This article proposes a practical guide supporting clinicians in integrating inspiratory muscle training into the care of mechanically ventilated patients experiencing weaning difficulties, informed by clinical experience and current evidence. The proposed approach focuses on the application of inspiratory muscle training in patients with weaning difficulties (mostly tracheostomized patients undergoing prolonged weaning), who fulfill readiness-to-wean criteria and are fully cooperative. Training sessions are typically conducted daily while the patient is disconnected from the ventilator, following an initial assessment of maximal inspiratory pressure and forced vital capacity. These parameters, along with volume displacement observed during each training session and symptom scores evaluated afterward, are used to individualize the initial external load and training progression. The main components that are taken into account to offer and individualize the training approach include patient selection, respiratory muscle and lung function assessment, load setting modalities, breathing instructions during training, and training progression guided by symptom scores and volume displacement.

Inspiratory muscle weakness is common among mechanically ventilated patients and is a well-recognized contributor to weaning difficulties, which are associated with poor outcomes and increased mortality. Inspiratory muscle training is a feasible and promising intervention that can improve global respiratory muscle strength and potentially facilitate successful liberation from mechanical ventilation in patients with weaning difficulties. This article proposes a practical guide supporting clinicians in integrating inspiratory muscle training into the care of mechanically ventilated patients experiencing weaning difficulties, informed by clinical experience and current evidence. The proposed approach focuses on the application of inspiratory muscle training in patients with weaning difficulties (mostly tracheostomized patients undergoing prolonged weaning), who fulfill readiness-to-wean criteria and are fully cooperative. Training sessions are typically conducted daily while the patient is disconnected from the ventilator, following an initial assessment of maximal inspiratory pressure and forced vital capacity. These parameters, along with volume displacement observed during each training session and symptom scores evaluated afterward, are used to individualize the initial external load and training progression. The main components that are taken into account to offer and individualize the training approach include patient selection, respiratory muscle and lung function assessment, load setting modalities, breathing instructions during training, and training progression guided by symptom scores and volume displacement.

Background: Menthol inhalation (MI) relieves dyspnoea in healthy individuals and people with respiratory disorders, independent of changes in breathing patterns and respiratory muscle electromyography activity. Thus, the underlying working mechanism of MI is unknown. We tested whether MI reduces dyspnoea by attenuating the neural processing of afferent respiratory sensations, without altering respiratory patterns and the efferent neural drive to breathe. Methods: Thirty healthy adults completed four 5-min trials of strong inspiratory resistive loaded breathing: two with MI and two with strawberry scent inhalation (SI; placebo control), in counterbalanced order. Paired inspiratory occlusions (150 ms) were randomly administered every 2–6 breaths to evoke respiratory-related evoked potentials (RREPs) in the electroencephalogram, reflecting neural processing of respiratory signals. Respiratory parameters were measured continuously, and neural drive to breathe was assessed via inspiratory occlusion pressure (P0.1). Dyspnoea intensity and unpleasantness were rated using the modified Borg scale, and five sensory dyspnoea qualities were rated using the Multidimensional Dyspnoea Profile. Results: Dyspnoea intensity (Δ=−0.67 modified Borg units, p=0.003, d=−0.56), air hunger (pvia a neural mechanism.

A multidisciplinary panel of lung cancer experts with a special interest in functional evaluation of lung cancer patients, and lung cancer patient representatives, has been facilitated by the European Society of Thoracic Surgeons and the European Respiratory Society to provide healthcare professionals with practical and up-to-date recommendations for the assessment of patients’ fitness for curative intent treatments for lung cancer. The panel formulated four PICO (population, intervention, comparison and outcomes) questions and seven complementary narrative questions. Both types of questions were assigned to groups of at least two experts. A medical librarian conducted the literature searches, and the authors selected relevant studies based on predefined inclusion criteria. Risk of bias was assessed using the QUIPS (Quality in Prognosis Studies) tool. Data were summarised and the certainty of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluations) and the Evidence to Decisions framework was used to formulate recommendations. A series of multidisciplinary recommendations was formulated about the utilisation of pulmonary function tests, split lung function values, exercise tests, cardiologic testing, and the role of prehabilitation, sublobar resections, risk scores and comorbidities in selecting patients for curative intent treatment.

A multidisciplinary panel of lung cancer experts with a special interest in functional evaluation of lung cancer patients, and lung cancer patient representatives, has been facilitated by the European Society of Thoracic Surgeons and the European Respiratory Society to provide healthcare professionals with practical and up-to-date recommendations for the assessment of patients’ fitness for curative intent treatments for lung cancer. The panel formulated four PICO (population, intervention, comparison and outcomes) questions and seven complementary narrative questions. Both types of questions were assigned to groups of at least two experts. A medical librarian conducted the literature searches, and the authors selected relevant studies based on predefined inclusion criteria. Risk of bias was assessed using the QUIPS (Quality in Prognosis Studies) tool. Data were summarised and the certainty of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluations) and the Evidence to Decisions framework was used to formulate recommendations. A series of multidisciplinary recommendations was formulated about the utilisation of pulmonary function tests, split lung function values, exercise tests, cardiologic testing, and the role of prehabilitation, sublobar resections, risk scores and comorbidities in selecting patients for curative intent treatment.

Inspiratory capacity (IC) measurement allows for the assessment of operating lung volumes during exercise and is the gold standard method for evaluating critical inspiratory constraints, particularly during cardiopulmonary exercise testing. Accurate measurement of IC depends on an individual's ability to give a maximal inspiratory effort to total lung capacity, which is assumed to remain constant throughout exercise [1]. Nonetheless, there is substantial evidence that IC is a reproducible measurement [2], and is responsive to both pharmacological (e.g., bronchodilators [3]) and non-pharmacological interventions (e.g., hyperoxia [4]).