To Örebro University

Rationale: In patients with COPD on long-term oxygen therapy (LTOT), oxygen doses are typically set at rest to maintain saturation above 90% while avoiding hyperoxemia, despite fluctuating needs throughout the day. Although emerging technology enables continuous, saturation-based adjustments, it is unclear whether such adjustments are feasible in a home setting. This pilot study assessed the feasibility and preliminary effect of saturation-responsive automated oxygen adjustments at home.

Methods: The intervention consisted of four days of continuous oxygen titration using an electronic device. Patients wore a wrist pulse oximeter that connected to the device via Bluetooth, creating a closed-loop system. In this setup, oxygen flow was adjusted from 1- 7 L/min based on real-time oxygen saturation (SpO₂), targeting a level of 90% to 94%. In the control period, the patients received their usual fixed oxygen, and they were not blinded to the intervention. Data were transmitted to a cloud-based solution. Feasibility was defined as successful time during which the patients were automatically titrated, patients´ willingness toward the intervention, and clinically relevance. The Clinical COPD Questionnaire (CCQ, 0-6 points, with 0.4 suggested as a minimal important difference) evaluated changes in the 24-hour health status.

Results: Twelve patients, four women and eight men with an average ±SD home oxygen dose of 2.0 ± 0.8 L/min were included. The patients' oxygen flow was automatically adjusted for a median (interquartile range) of 77 (68.0-84.3) hours per patient, reflecting 83% of the time they were compliant with wearing the equipment. More than 217,000 paired live data points on SpO2 and oxygen flow were received on average per patient. The time spent within target was statistically different between arms with 51.3 ± 12.2% when using fixed oxygen flow, and 83.4 ± 8.3% of the time when flow was automatically adjusted, p<0.001. Complaints from the patients were mainly regarding the noise from the 9 L oxygen concentrator. A change in the CCQ score of 0.74 ± 0.47 points favored the automated oxygen titration, p<0.001.

Conclusion: It is possible to titrate oxygen flow in a home setting and achieve almost perfect control of SpO2, minimizing time with hypoxemia. The patients in this pilot study accepted the equipment and reported a statistical and clinically significant reduction in COPD symptoms measured with CCQ. The clinical importance of controlling SpO2 needs to be examined in a larger study.

In spontaneously breathing patients, breathing exercises with positive expiratory pressure (PEP) can be used in various physiological ways to reopen closed airways by increasing the functional residual capacity (FRC) in hypoventilating patients, handle dyspnoea by decreasing the FRC, or reopen clogged airways and maintain an expiratory flow at low lung levels as part of airway clearance therapy. To make the most out of the treatment, the caregiver needs to know the pathophysiology and desired physiological effect of the treatment plan. This article presents the background of the application of PEP and gives information about frequently asked clinical questions. Based on this knowledge, individual prescriptions should be given to each patient including correct instruction and training on how to use PEP and how to adjust when the situation/condition changes. If daily long-term treatment is recommended, the patient needs regular return visits to monitor the effectiveness and evaluate it together with the patient, and to re-educate the patient as soon as needed.

BACKGROUND: Minimising hypoxaemia during submaximal walking tests has a positive effect on exercise capacity and dyspnoea in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). However, the impact of optimising oxygenation during everyday tasks remains unexplored. Therefore, we investigated the effects of maintaining a target saturation on activities of daily living (ADL) using automated oxygen titration compared with conventional fixed oxygen flow.

METHODS: In a double-blinded, randomised crossover trial, patients with COPD on LTOT performed two GlittreADL tests to assess the functional capacity of everyday activities using (1) their fixed oxygen dose and (2) an adjusted flow from 0 to 8 L/min targeting a peripheral oxygen saturation (SpO2) of 90-94%. A closed-loop device automatically titrated the oxygen based on information from a Bluetooth wrist pulse oximeter.

RESULTS: 31 patients (mean±SD age: 72.8±5.9 years, forced expiratory volume in 1 s of % predicted: 36.7±12.7) were included. The patients reduced the time to perform the ADL test by median (IQR) 38 (12-73) s, p<0.001, using automated titration compared with the fixed oxygen flow. The oxygen flow in the automated arm more than tripled to 5.4 (4.1-6.8) versus 1.6 (1.1-2.1) L/min (fixed) during the test, p<0.001, while the time spent within SpO2-target was increased from 19% to 49%, p=0.002. Correspondingly, the patients experienced less dyspnoea (BorgCR10); 5 (3-7) versus 6 (4-8), p<0.001, in favour of the automated oxygen titration.

CONCLUSIONS: Improving oxygenation and extending the time spent within target saturation reduced dyspnoea and improved functional capacity in ADL in patients with COPD on LTOT.

TRIAL REGISTRATION NUMBER: NCT05553847.

This study assessed patient-reported experiences and perceived respiratory outcomes of home-based deep breathing exercises 3 months after cardiac surgery. A postal questionnaire was sent to 120 patients at a Swedish university hospital, with 92 respondents (77%). The majority (89%) performed breathing exercises after discharge, with 77% reporting them as very easy to perform. Most patients continued the exercises for 2 to 4 weeks (41%) or 1 to 2 months (20%), typically practicing 3 times per day. The exercises were well tolerated, with 87% experiencing no discomfort. Motivation was generally high-43% felt very motivated, and 78% found the exercises useful. While chest pain was reported as low and 56% experienced improved breathing, nearly half of the respondents reported difficulties with coughing, and 10% sought medical care for respiratory infections. Overall, home-based deep breathing exercises were perceived as beneficial and well accepted. However, engagement and adherence varied, highlighting the need for tailored support to encourage sustained participation.

BACKGROUND: Lung cancer is one of the most frequently diagnosed cancers, and the leading cause of cancer deaths worldwide. Surgical resection is the primary curative treatment. The World Health Organization (WHO) recommends that all adults, including cancer survivors, should engage in at least 150 to 300 min of moderate-intensity aerobic physical activity per week. Positive associations have been found between self-reported physical activity and health-related quality of life (HRQoL) after lung cancer surgery. However, there is a lack of studies concerning objectively measured physical activity levels, and longer follow-ups are also missing. This study investigated the relationship between objectively measured physical activity levels and HRQoL in patients 3 and 12 months after lung cancer surgery.

METHODS: Utilizing a cross-sectional design, patients were followed up 3 (n = 83) and 12 (n = 57) months after lung cancer surgery. HRQoL was assessed with the cancer-specific questionnaire EORTC QLQ-C30 and the lung-cancer-specific module LC13. Physical activity was measured with a tri-axial accelerometer (ActiGraph GT3X+).

RESULTS: At 3 months after surgery, 51% (n = 42) of the patients reached the level of physical activity recommended by the WHO; the corresponding result at 12 months was 42% (n = 24). Patients who reached the recommended level of physical activity reported a better HRQoL, with better global health status and physical function as well as lower symptoms of fatigue, at both 3 and 12 months postoperatively.

CONCLUSIONS: Physical activity was positively associated with HRQoL. Encouraging and supporting patients to engage in regular physical activity could contribute to better HRQoL after lung cancer surgery.

TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (NCT01961700), registration date 20,131,009.

INTRODUCTION: A new flow-regulated PEP device has been evaluated regarding functionality and pressure properties.

METHODS: The three different resistance levels were assessed and evaluated at standardized flow rates of 10 and 18 L/min; Kruskal-Wallis test was used to analyse the differences in generated pressure between the different resistance levels.

RESULTS: A range of 3-31 cmH2O was generated with airflows of 10 and 18 L/min. There was a significant difference in pressure among different resistance levels at both flow rates.

CONCLUSION: Overall, there was a significant difference in pressure among different resistance levels at both flow rates, showing that the high resistance significantly increased pressure compared with low resistance. This new device is performing comparable with other resistors available in the market.

Rationale: The present study included the first patients with COPD on long-term oxygen therapy who experienced second-by-second oxygen adjustments in their homes based on oxygen saturation. A device capable of automatically titrating the patient's oxygen was installed in the patients´ home aiming at increasing the time spent within target saturation. We explored patients´ experiences with this automated home oxygen titration, focusing on how maintaining target saturation affected daily life.

Methods: Semi-structured interviews were conducted with eight men and four women after they have had the automated oxygen equipment installation in their homes. Systematic text condensation was used in the analysis.

Results: Three main themes emerged from patient narratives: 1) "This is my life" - Patients preferred maintaining stable oxygen saturation, associating hypoxemia with dyspnea, discomfort, and difficulties with daily tasks. 2) "Getting the oxygen, I need" - Many patients reported improved ability to perform daily activities when oxygen was automatically adjusted. 3) "New technology gives hope for my life" - Patients expressed optimism about the potential of home-based technology, offering suggestions to improve usability, mainly by reducing concentrator noise.

Conclusion: Our findings suggested high acceptability of the automated oxygen in the patients´ home, as they believed it to increase the time spend with sufficient oxygen, especially during daily activities. Integrating patient insights is essential for implementation and acceptance of automated home oxygen therapy.

The present study included the first patients with COPD on long-term oxygen therapy who experienced second-by-second oxygen adjustments in their homes based on oxygen saturation. A device capable of automatically titrating the patient's oxygen was installed in the patients' home aiming at increasing the time spent within target saturation. We explored patients' experiences with this automated home oxygen titration, focusing on how maintaining target saturation affected daily life. Semi-structured interviews were conducted with eight men and four women after installation. Systematic text condensation was used in the analysis. Three main themes emerged from patient narratives: (1) "This is my life" - Patients preferred maintaining stable oxygen saturation, associating hypoxemia with dyspnea, discomfort, and difficulties with daily tasks. (2) "Getting the oxygen, I need" - Many patients reported improved ability to perform daily activities when oxygen was automatically adjusted. (3) "New technology gives hope for my life" - Patients expressed optimism about the potential of home-based technology, offering suggestions to improve usability, mainly by reducing concentrator noise. Our findings suggested high acceptability of the automated oxygen in the patients' home, as they believed it to increase the time spend with sufficient oxygen, especially during daily activities. Integrating patient insights is essential for implementation and acceptance of automated home oxygen therapy.

OBJECTIVES: To describe the timing and type of the first targeted breathing exercises after abdominal and cardiothoracic surgery, and to identify factors associated with early initiation (Commencement within three hours after arriival to a postoperative ward).

DESIGN: Multicentre observational study. METHODS: In 18 hospitals in Sweden, the start time and type of targeted breathing exercises were recorded in consecutive series of patients who underwent abdominal or cardiothoracic surgery. Demographic data were retrieved from hospital records. Patients were divided into seven groups based on the category of surgery.

RESULTS: In total, 1492 patients were included in this study; of these, 1128 (76%) performed some form of targeted breathing exercise after surgery. Targeted breathing exercises commenced a median of 3.63 hours (interquartile range 1.58 to 11.75 hours) after arrival on a postoperative ward, with earlier commencement after minor abdominal surgery and later commencement after major abdominal surgery (P < 0.001). Most patients who performed targeted breathing exercises used positive expiratory pressure (n = 968/1492, 65%) or deep breathing without any devices (n = 207/1492, 14%). The odds of initiating breathing exercises within the first 3 hours after arrival on a postoperative ward were higher if a patient underwent pulmonary or abdominal surgery [odds ratio (OR) > 2.04; P < 0.001], or had intravenous analgesia (OR 1.50, 95% CI 1.05 to 2.14; P = 0.026). The odds were lower (OR 0.43, 95% CI 0.21 to 0.88; P = 0.021) for patients who arrived on the postoperative ward in the evening/night or for patients who had undergone laparoscopic surgery (OR 0.63, 0.43-0.92, p=0.018).

CONCLUSION: The majority (76%) of patients undergoing abdominal or cardiothoracic surgery performed some form of targeted breathing exercise, starting a median of 3.63 hours after arrival on a postoperative ward. TRIAL

REGISTRATION: "FoU in Sweden" (Research and Development in Sweden) ID: 275357 and Clinical Trials NCT04729634. CONTRIBUTION OF THE PAPER.

BACKGROUND: Postoperative surgical site infection is a serious problem. Coverage of sterile goods may be important to protect the goods from bacterial air contamination while awaiting surgery.

AIM: We aimed to evaluate the effectiveness of this practice in a systematic review covering five databases using search terms related to bacterial contamination in the operating room and on surgical instruments.

METHODS: We searched MEDLINE, Cochrane, CINAHL, EMBASE, and Web of Science from database inception to February 13, 2023, for randomized and non-randomized controlled studies of covering interventions conducted in the operating room setting. The outcome was bacterial air contamination measured as colony forming units, and a meta-analysis was performed in separate time periods of coverage. This systematic review and meta-analysis is reported according to the PRISMA statement, and the protocol was prospectively registered in PROSPERO (CRD42022323113). The time points ranged from 30 minutes to 24 hours.

FINDINGS: The results showed that covering sterile goods significantly prevented bacterial air contamination as compared to uncovered goods. The meta-analysis was in favour of covering sterile goods for protection from bacterial air contamination, and showed an effect size Z of 4.76 (p<0.00001, CI: -1.94 to -0.81). The heterogeneity analysis showed a heterogeneity of 83%.

CONCLUSION: No negative effects regarding bacterial contamination were found, and so we conclude that protection with a sterile cover decreases bacterial air contamination of sterile goods while waiting for surgery to start.