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Inleiding: ‘High-flow nasal cannula’ (HFNC) is een relatief nieuwe vorm van respiratoire ondersteuning. Deze review heeft tot doel een overzicht te geven van de huidige evidentie over de effectiviteit en de veiligheid van HFNC bij bronchiolitis en hieruit de implicaties voor de klinische praktijk af te leiden. Methode: Een systematisch literatuuronderzoek werd uitgevoerd in Pubmed, Embase en CENTRAL. Studies bij kinderen jonger dan 2 jaar met bronchiolitis behandeld met HFNC, waarin HFNC vergeleken werd met standaard zuurstoftherapie of met ‘nasal continuous positive airway pressure’ (nCPAP), werden geïncludeerd. Resultaten: Er werden 13 artikels geïncludeerd met in totaal 2399 patiënten. Er was minder therapiefalen met HFNC dan met standaard zuurstoftherapie en met nCPAP dan met HFNC. Bij falen was er een grote kans op succes bij overschakelen van standaard zuurstoftherapie naar HFNC en van HFNC naar nCPAP. Er werd in de meeste studies geen significant verschil waargenomen in opname op de pediatrische intensieve zorgenafdeling, in hospitalisatieduur, in duur van zuurstoftherapie en in duur van verblijf op de pediatrische intensieve zorgenafdeling. Intubatie was zelden nodig. Respiratoire acidose en de veranderingen in hart- en ademhalingsfrequentie kunnen gebruikt worden als voorspellende factoren voor falen van HFNC. Ernstige nevenwerkingen traden niet op. Conclusie: Op basis van de huidige evidentie lijkt het aangewezen om respiratoire ondersteuning bij bronchiolitis trapsgewijs op te bouwen door te starten met standaard zuurstoftherapie en bij therapiefalen over te schakelen naar HFNC en vervolgens naar nCPAP of invasieve ventilatie.

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Background: Cystic fibrosis is a hereditary chronic and life shortening disease in which patients face recurrent and chronic lung infections often treated by antibiotics. Due to antimicrobial resistance these pulmonary infections are often caused by therapy-resistant pathogens. This forces the health care system to develop alternative therapies such as bacteriophage therapy. Thus far, however, there are no clinical guidelines on the use of phage therapy in cystic fibrosis patients. Objectives: This literature review examines the existing evidence of the use of bacteriophages in the care of lung infections in patients with cystic fibrosis. Methods: This is a narrative review identifying the relevant studies published in English in the last ten years. We searched articles on PubMed and Embase. The search terms included: “cystic fibrosis” and “phage therapy” or “bacteriophage therapy”. Additionally, we backward searched for articles in the reference lists of the relevant studies. Results: We included 15 articles of which 9 were case reports. A wide variety was used in terms of administration methods, treatment regimens and number of phages administered, clinical outcome and concomitant treatment with antibiotics. In most case reports, the phage therapy resulted in eradication of the causative pathogens and clinical improvement was documented for most treated patients. Other studies report on in vitro effect and on the use of phage therapy in lung infection in animal studies. Conclusion: The available literature is limited to case reports and a low number of in vitro and animal studies. This limited evidence suggests that the implementation of bacteriophage therapy into the treatment of lung infections in patients with cystic fibrosis is a promising tool. Bacteriophages may play an important factor in solving the global problem of antibiotic resistance in these patients. However, further research and statistically significant findings are needed to substantiate this.

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II. ABSTRACT 1. Introduction In the University Hospital of Leuven, sweat testing (ST) is being performed according to the Gibson and Cooke pilocarpine iontophoresis method and sweat chloride levels (SCL) are measured by coulorimetry (Sherwood M926S®) (GCT-C). The aim was to compare this method with a Macroduct Sweat Collection System and a chloridometer (Chlorochek®) (MSCS-CC). 2. Materials and methods This is a monocentric prospective study including patients referred for ST between March 2020 and August 2021. If informed consent was given, GCT-C and MSCS-CC were performed consecutively on a different arm. We compared QNS, success rate, correlation for Cl values and discrepant results for both test methods. 3. Results 70 patients participated with a median (IQR) age of 2.05 (0.28-4.40) years. For one participant data on MSCS-CC testing were missing. The GCT-C was successful in 56 patients (80.0%) (n=12 QNS, 2 other technical reason) while the MSCS-CC was performed in 69/70 patients and successful in 51 (73.9%) (n= 15 QNS and n=3 other technical reason) but this difference was NS (p> 0.05). In the age group < 3 months, success rate in the MSCS-CC (9/16) was significantly lower compared to the GCT-C (15/17) (p=0.04). Six patients had a SCL value > 60 mmol/l (all confirmed CF diagnosis) with the GCT and 4/6 had successful MSCS-CC with concordant results. In only one patient a discordant result was obtained (SCL 25.6 mmol/l with GCT-C and 33 with MSCS-CC), but CF was excluded. Correlation between both SCL values was high (r2= 0.974; p< 0.001). However, SCL obtained with the MSCS set-up were significantly higher (mean difference 3.68 mmol/l ; p< 0.005). 4. Conclusion Success rate should be improved for both techniques. In the NBS group, success rate of MSCS is too low. Procedures are being reviewed.