Center for Pneumology and Thoracic Surgery

Großhansdorf, Germany

Center for Pneumology and Thoracic Surgery

Großhansdorf, Germany
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Kohnlein T.,Hannover Medical School | Windisch W.,Witten/Herdecke University | Kohler D.,Fachkrankenhaus Kloster Grafschaft | Drabik A.,University of Hamburg | And 11 more authors.
The Lancet Respiratory Medicine | Year: 2014

Background: Evidence is weak for the ability of long-term non-invasive positive pressure ventilation (NPPV) to improve survival in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). Previous prospective studies did not target a reduction in hypercapnia when adjusting ventilator settings. This study investigated the effect of long-term NPPV, targeted to markedly reduce hypercapnia, on survival in patients with advanced, stable hypercapnic COPD. Methods: This investigator-initiated, prospective, multicentre, randomised, controlled clinical trial enrolled patients with stable GOLD stage IV COPD and a partial carbon dioxide pressure (PaCO2) of 7 kPa (51·9 mm Hg) or higher and pH higher than 7·35. NPPV was targeted to reduce baseline PaCO2 by at least 20% or to achieve PaCO2 values lower than 6·5 kPa (48·1 mm Hg). Patients were randomly assigned (in a 1:1 ratio) via a computer-generated randomisation sequence with a block size of four, to continue optimised standard treatment (control group) or to receive additional NPPV for at least 12 months (intervention group). The primary outcome was 1-year all-cause mortality. Analysis was by intention to treat. The intervention was unblinded, but outcome assessment was blinded to treatment assignment. This study is registered with ClinicalTrials.gov, number NCT00710541. Findings: Patients were recruited from 36 respiratory units in Germany and Austria, starting on Oct 29, 2004, and terminated with a record of the vital status on July 31, 2011. 195 patients were randomly assigned to the NPPV group (n=102) or to the control group (n=93). All patients from the control group and the NPPV group were included in the primary analysis. 1-year mortality was 12% (12 of 102 patients) in the intervention group and 33% (31 of 93 patients) in the control group; hazard ratio 0·24 (95% CI 0·11-0·49; p=0·0004). 14 (14%) patients reported facial skin rash, which could be managed by changing the type of the mask. No other intervention-related adverse events were reported. Interpretation: The addition of long-term NPPV to standard treatment improves survival of patients with hypercapnic, stable COPD when NPPV is targeted to greatly reduce hypercapnia. Funding: German Lung Foundation; ResMed, Germany; Tyco Healthcare, Germany; and Weinmann, Germany. © 2014 Elsevier Ltd.


Biancosino C.,Hannover Medical School | Biancosino C.,Witten/Herdecke University | Welker L.,Center for Pneumology and Thoracic Surgery | Kruger M.,Hannover Medical School | And 3 more authors.
Pneumologie | Year: 2016

Background: History, clinical presentation, lung function testing, radiographs including HRCT and nonsurgical biopsy techniques in most cases provide sufficient information for classification of interstitial lung disease (ILD). However, in a small percentage it is not possible to establish the diagnosis so that lung biopsy may be required. We analyzed under which circumstances a reduction of invasive procedures is reasonable. Methods: Between January 1997 and December 2009 we examined 3399 specimens from 1299 patients with benign inflammatory and granulomatous diseases in whom ILD was clinically hypothesized. We compared the probability of disease according to Bayes before and after surgery which corresponds to the clinical diagnosis (a priori probability) and the final diagnosis (a posteriori probability). Additionally, procedures, operation related complications and the patients smoking habits were documented. Results: In 111 patients (8.5%) surgical evaluation was performed (14 mediastinoscopies, 97 thoracotomies/VATS biopsies). All mediastinoscopies substantiated a epitheloid cell granulomatosis. In 30% of all VATS procedures a prolonged air leak of more than 4 days was observed. One patient died and one had to get a new chest tube after removal. Changes of a priori/a posteriori probabilities was shown for non-smokers in Wegners granulomatosis (0.6 vs. 2.2%) and IPF (16.7 vs. 34.8%), for smokers in Langerhans cell histiocytosis (1.4 vs. 7.8%) and IPF (16.7 vs. 33.3%). In the majority of cases even a reduction of probability was seen. Conclusion: Considering complications and limited diagnostic gain, lung biopsies for diagnosis of ILD should be recommended only in selected patients. © 2016 Georg Thieme Verlag KG Stuttgart New York.


PubMed | Hannover Medical School, Center for Pneumology and Thoracic Surgery, Witten/Herdecke University and Institute of Pathology
Type: Evaluation Studies | Journal: Pneumologie (Stuttgart, Germany) | Year: 2016

History, clinical presentation, lung function testing, radiographs including HRCT and nonsurgical biopsy techniques in most cases provide sufficient information for classification of interstitial lung disease (ILD). However, in a small percentage it is not possible to establish the diagnosis so that lung biopsy may be required. We analyzed under which circumstances a reduction of invasive procedures is reasonable.Between January 1997 and December 2009 we examined 3399 specimens from 1299 patients with benign inflammatory and granulomatous diseases in whom ILD was clinically hypothesized. We compared the probability of disease according to Bayes before and after surgery which corresponds to the clinical diagnosis (a priori probability) and the final diagnosis (a posteriori probability). Additionally, procedures, operation related complications and the patients smoking habits were documented.In 111 patients (8.5%) surgical evaluation was performed (14 mediastinoscopies, 97 thoracotomies/VATS biopsies). All mediastinoscopies substantiated a epitheloid cell granulomatosis. In 30% of all VATS procedures a prolonged air leak of more than 4 days was observed. One patient died and one had to get a new chest tube after removal. Changes of a priori/a posteriori probabilities was shown for non-smokers in Wegners granulomatosis (0.6 vs. 2.2%) and IPF (16.7 vs. 34.8%), for smokers in Langerhans cell histiocytosis (1.4 vs. 7.8%) and IPF (16.7 vs. 33.3%). In the majority of cases even a reduction of probability was seen.Considering complications and limited diagnostic gain, lung biopsies for diagnosis of ILD should be recommended only in selected patients.

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