Respiration; international review of thoracic diseases
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Respiratory failure is the leading cause of death in patients with amyotrophic lateral sclerosis (ALS). We review the physiology of respiratory compromise in ALS and techniques of monitoring respiratory function. Treatment options, including pharmacologic interventions, aspiration precautions, and invasive and noninvasive modes of mechanical ventilation are reviewed. ⋯ Four of 18 patients who elected to receive noninvasive ventilation decided to discontinue treatment. Four of 13 patients who were receiving mechanical ventilation elected to discontinue life support. The decision to utilize these modalities must be made with realistic considerations of the patient's quality of life.
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The influence of acculturation to a sedentary lifestyle upon the growth and development of lung volumes has been studied in Inuit children aged 9-19 years. Surveys were conducted in the circumpolar community of Igloolik (69 degrees 40'N, 81 degrees W) in 1969/70, 1979/80 and 1989/90. Over this period, the children showed little change of height or body mass at any given age, but a progressive loss of what initially had been a high level of health-related fitness. ⋯ Nevertheless, lung volumes show the anticipated increase as a logarithmic function of stature. Furthermore, statistically fitted curves show only minor inter-survey differences in volumes for a given standing height. We thus conclude that the deterioration in other aspects of health-related fitness has not yet influenced the growth and development of respiratory function within this Inuit population.
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Bi-level pressure support ventilation via a nasal mask (NIPSV) was provided to 28 consecutive unselected patients with acute respiratory failure due to exacerbation of chronic obstructive pulmonary failure (COPD). If NIPSV improved gas exchange within 2 h, it was continued. Otherwise, patients would be promptly intubated. ⋯ Eighteen patients (64%) were successfully ventilated with NIPSV, while in 10 (36%) NIPSV failed. A high Apache II score, but not admission blood gas exchange or respiratory rate, seems to be correlated with the failure to ventilate with NIPSV. The results of our preliminary experience suggest the use of NIPSV as an initial approach to acute respiratory failure due to exacerbation of COPD, particularly in patients with an Apache II score of less than 29.