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Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The implementation of NAVA requires the introduction of …

Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation in which both the timing and degree of ventilatory assist are controlled by the patient. Since NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized non-invasive NAVA (NI …

The University of Colorado Medicine's population health initiative provided mixed results on medication adherence metrics. Electronic health record messaging provided insight into ways to improve the intervention to better engage and assist patients.

Background The ever-increasing number of patients diagnosed with obstructive sleep apnoea (OSA) and treated by long-term continuous positive airway pressure (CPAP) overstretches conventional follow-up pathways. New approaches to the management of CPAP-treated patient follow-up are needed to strike a balance between remote monitoring through digital technologies and in-person patient-healthcare-professional contacts. Focusing on the reshaping of the management of care pathways of CPAP-treated patients, with a specific focus on telemonitoring platforms, we aimed to review the evidence on how digital medicine and artificial intelligence (AI) tools are facilitating patient phenotyping and triage, risk stratification and the allocation of resources between the various healthcare professionals for an optimal follow-up of CPAP-treated patients. Phenotyping OSA is a heterogeneous condition with diverse phenotypes differing in symptoms, comorbidities, demographics, lifestyle and socioeconomic context. Different phenotypes are associated with different CPAP adherence patterns and differing long-term prognosis. This diversity demands greater plurality in management pathways with different types and levels of support to ensure treatment adherence and risk reduction for patients while easing the burden on health services. In multidimensional phenotyping, we discuss alternatives to the apnoea hypopnoea index (AHI) as a measure of OSA severity. Then we consider risk stratification taking advantage of the wealth of CPAP monitoring data already available in databases that can now be exploited using AI and machine learning to direct (stratify) patients into appropriate follow-up management pathways. Integrated care clinics for high-risk patients We look at the role of integrated OSA care clinics particularly for the management of high-risk patients with low adherence and progression of comorbidities. Here, multidisciplinary teams might propose comorbidity management, and the use of connected wearable devices for long-term monitoring of physical activity, along with remote CPAP monitoring. Remote management pathways The pros and cons of remote management pathways to replace in-person follow-up visits are considered, including the need to re-evaluate CPAP-device reimbursement policies in some countries. While remote CPAP monitoring has become the cornerstone of follow-up providing information on adherence and efficacy, the processing of alerts needs to be improved, particularly regarding mask changes and early detection of CPAP failures. Challenges The implementation of CPAP monitoring alone, as well as its extension to multimodal monitoring, can present challenges that remain to be addressed (eg, access to digital care). The extent and components of remote follow-up must be adapted to each specific OSA phenotype. Finally, we give examples of certain patient phenotypes (eg, comorbid insomnia with OSA) with specific follow-up requirements, for which remote (even multimodal) monitoring alone has limitations and the intervention of both sleep specialists and/or their colleagues from other disciplines is needed. Conclusion Appropriately tailored combined digital and in-person CPAP follow-up pathways would present advantages both for patients with OSA and healthcare services.

The study was approved by the research overview of the Capital of Denmark and the Center for Health.

In this cross-sectional study of adults eligible for cancer screening, findings revealed notable variations in screening patterns by both screening type and sex. Given that these risks may not always align with patient-centered social needs, further research focusing on specific target populations i …

To investigate the effect of positive end-expiratory pressure (PEEP) guided by transpulmonary pressure or with maximum oxygenation-directed PEEP on lung injury in a porcine model of acute respiratory distress syndrome (ARDS). The porcine model of ARDS was induced in 12 standard pigs by intratracheal …

(www.crd.york.ac.uk/prospero) under ID CRD42021227231.

The failure of noninvasive ventilatory support to reduce respiratory effort may exacerbate pulmonary injury in patients with early COVID-19 pneumonia. HFNOT reduces lung strain and achieves similar oxygenation to CPAP/NIV. Invasive mechanical ventilation may be less injurious than noninvasive suppor …

Reverse triggering is an underdiagnosed form of patient-ventilator asynchrony in which a passive ventilator-delivered breath triggers a neural response resulting in involuntary patient effort and diaphragmatic contraction. Reverse triggering may significantly impact patient outcomes, and the unique …

The aim of mechanical ventilation is to assure gas exchange while efficiently unloading the respiratory muscles and mechanical ventilation is an integral part of the care of patients with acute respiratory failure. Modern lung protective strategies of mechanical ventilation include low-tidal-volume …

Among patients with ineffective triggering under PSV, PSL adjustment failed to eliminate asynchrony in 58% of them (21 of 36 patients). In these patients with refractory ineffective triggering, switching from PSV to PAV+ significantly reduced or even suppressed the incidence of asynchrony.

We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.0 …

In tracheostomized patients at high risk of weaning failure from mechanical ventilation, T-HF did not improve neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange compared with conventional O2 after disconnection from the ventilator. The present findings might sug …

Proportional modes of ventilation assist the patient by adapting to his/her effort, which contrasts with all other modes. The two proportional modes are referred to as neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation with load-adjustable gain factors (PAV+): they deliv …

Selective attention allows us to ignore what is task-irrelevant and focus on what is task-relevant. The cognitive and neural mechanisms that underlie this process are key topics of investigation in cognitive psychology. One of the more prominent theories of attention is perceptual load theory, which suggests that the efficiency of selective attention is dependent on both perceptual and cognitive load. It is now more than 20 years since the proposal of load theory, and it is a good time to evaluate the evidence in support of this influential model. The present article supplements and extends previous reviews (Lavie, Trends in Cognitive Sciences, 9, 75–82. doi: 10.1016/j.tics.2004.12.004 , 2005, Current Directions in Psychological Science, 19, 143–148. doi: 10.1177/0963721410370295 , 2010) by examining more recent research in what appears to be a rapidly expanding area. The article comprises five parts, examining (1) evidence for the effects of perceptual load on attention, (2) cognitive load, (3) individual differences under load, (4) alternative theories and criticisms, and (5) the future of load theory. We argue that the key next step for load theory will be the application of the model to real-world tasks. The potential benefits of applied attention research are numerous, and there is tentative evidence that applied research would provide strong support for the theory itself, as well as real-world benefits related to activities in which attention is crucial, such as driving and education.

Many studies have shown that increasing the number of neutral stimuli in a display decreases distractor interference. This result has been interpreted within two different frameworks; a perceptual load account, based on a reduction in spare ...

The theory of perceptual load (Lavie & Tsal, 1994) proposes that with low load in relevant processing left over resources spill over to process irrele…

Previous researches have widely demonstrated that the interference from peripheral distractor will decrease when the task load is high. However, no study to date has paid attention to the individual differences in perceptual load effect (PLE) and ...

According to perceptual load theory (Lavie, 2005) distractor interference is determined by the availability of attentional resources. If target processing do...

The load theory of selective attention hypothesizes that distractor interference is suppressed after perceptual processing (i.e., in the later stage of central processing) at low perceptual load of the central task, but in the early stage of ...

Perceptual load is a key determinant of distraction by task-irrelevant stimuli (e.g., Lavie, N. (2005). Distracted and confused?: Selective attention …

People often make slower decisions after switching perceptual tasks. The authors show that this is due to a limitation in the decision-making process in the optimization of sensory information flow, which recovers shortly after receiving sensory input.

Healthy adults performed an auditory version of the flanker task under low versus high perceptual load while behavioral and electrophysiological measu…

Perceptual load theory (Lavie, 2005) claims that attentional capacity that is not used for the current task is allocated to irrelevant distractors. It predicts that if the attentional demands of the current task are high, distractor interference will be low. One particularly powerful demonstration o …