RationaleThe conventional approach of low-intensity non-invasive positive pressure ventilation (NPPV) produces only minimal physiological and clinical benefits in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). Objectives To determine whether the novel approach of high-intensity NPPV is superior to low-intensity NPPV in controlling nocturnal hypoventilation. Methods A randomised controlled crossover trial comparing 6 weeks of high-intensity NPPV (using controlled ventilation with mean inspiratory pressures of 28.661.9 mbar) with low-intensity NPPV (using assisted ventilation with mean inspiratory pressures of 14.660.8 mbar) was performed in 17 patients with severe stable hypercapnic COPD. Results Two patients refused low-intensity NPPV and two patients dropped out while on low-intensity NPPV. Thirteen patients (mean forced expiratory volume in 1 s (FEV 1 ) 0.7660.29 l) completed the trial. High-intensity NPPV produced higher pneumotachographicallymeasured expiratory volumes, with a mean treatment effect of 96 ml (95% CI 23 to 169) (p¼0.015). This resulted in a mean treatment effect on nocturnal arterial carbon dioxide tension (Paco 2 ) of À9.2 mm Hg (95% CI À13.7 to À4.6) (p¼0.001) in favour of high-intensity NPPV. Daily use of NPPV was increased in high-intensity NPPV compared with low-intensity NPPV, with a mean difference of 3.6 h/day (95% CI 0.6 to 6.7) (p¼0.024). In addition, compared with baseline, only high-intensity NPPV resulted in significant improvements in exerciserelated dyspnoea, daytime Paco 2 , FEV 1 , vital capacity and the Severe Respiratory Insufficiency Questionnaire Summary Score. Conclusions High-intensity NPPV is better tolerated by patients with severe chronic hypercapnic COPD and has been shown to be superior to the conventional and widely-used form of low-intensity NPPV in controlling nocturnal hypoventilation. High-intensity NPPV therefore offers a new promising therapeutic option for these patients.

A certain degree of one antigen mismatching may not compromise the outcome after UD SCT when using this rabbit ATG in addition to standard GVHD prophylaxis regimen.

Background: Correct measurement of PO₂ and PCO₂ is essential to establish appropriate therapy such as long-term oxygen therapy (LTOT) in patients suffering from respiratory failure. Objectives: We aimed to compare common invasive and noninvasive methods for assessing blood gas components for spot check analysis. Methods: Arterial (P_aO₂, P_aCO₂) and capillary blood gas (P_CBGO₂, P_CBGCO₂) measurements were taken consecutively in a randomized order and were compared with noninvasive measurements obtained from the transcutaneous monitoring of PO₂ and PCO₂ (P_tcO₂, P_tcCO₂, sensor-temperature 44°C). Capillary samples were taken from both arterialized earlobes, where samples of right earlobes were defined as a reference value. Pain assessment of all measurements was evaluated by each subject using the 100-mm visual analogue scale. Results: 83 patients and 17 healthy subjects were included. The mean difference between P_aO₂ and P_tcO₂ was 11.9 ± 15.0 mm Hg, with lower limits of agreement (LLA) of -17.4 mm Hg (95% confidence interval (CI) -22.5 to -12.3 mm Hg), and upper limits of agreement (ULA) of 41.1 mm Hg (95% CI 36.0-46.2 mm Hg). The comparison of P_aO₂ with P_CBGO₂ showed a mean difference of 5.6 ± 7.2 mm Hg (LLA -11.0; ULA 19.6 mm Hg). The mean difference between P_aCO₂ and P_tcCO₂ was 1.1 ± 4.9 mm Hg (LLA -8.6; ULA 10.8 mm Hg) and that between P_aCO₂ and P_CBGCO₂ was 0.7 ± 2.0 mm Hg (LLA -3.3; ULA 4.8 mm Hg). The analysis of capillary blood gases (36.2 ± 22.3 mm) was rated as more painful than the analysis of arterial blood gases (26.1 ± 20.6 mm), while transcutaneous measurement was rated as the least painful method (1.9 ± 7.4 mm; all p < 0.0001). Conclusions: The comparison of different methods for blood gas measurements showed substantial differences between capillary and arterial PO₂ and between transcutaneous and arterial PO₂. Therefore, arterial PO₂ analysis is the essential method evaluating indication for LTOT. Nevertheless, comparative analysis further indicated capillary PCO₂ as an adequate surrogate for arterial PCO₂.

To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol, and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site; (ii) positive culture from the catheter tip (> or = 15 CFU); and (iii) occurrence of CVC-associated bloodstream infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p <0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%) than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine had a non-significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44; 95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial supports the results of two observational studies demonstrating octenidine in alcoholic solution to be a better option than alcohol alone for the prevention of CVC-associated infections.