Respiration; international review of thoracic diseases
-
Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of intercostal cryoanalgesia versus conventional analgesia in postthoracotomy pain.
The objective of the study was to evaluate the effects of cryoanalgesia in patients undergoing posterolateral thoracotomy. A double-blind randomized and prospective study was performed in 100 patients undergoing thoracotomy. They were randomized into two groups: Group A, 55 patients, who had undergone an intercostal cryoanalgesia and group B, control, 45 patients treated only with pharmacological analgesia ad libitum. ⋯ Maximal static inspiratory pressure (PImax) showed no significant changes and no significant differences were found between the two groups. Maximal static expiratory pressure (PEmax) significantly decreased (p < 0.001) in the 1st and 2nd week and it was not related to the type of analgesia used. We advocate the use of cryoanalgesia since it significantly reduces pain as well as the doses of analgesia.
-
Randomized Controlled Trial Clinical Trial
Evaluation of the use of three different devices for nocturnal oxygen therapy in COPD patients.
To determine whether transtracheal catheter and reservoir nasal cannula contribute to maintaining adequate oxygen saturation during sleep, and to calculate the oxygen saving they allow compared to nasal prongs. ⋯ The oxymizer device and transtracheal oxygen delivery benefit hypoxemic COPD patients reducing oxygen use during sleep by around 50%. Higher PaO2 levels were necessary to prevent nocturnal SaO2 decreases in patients with nasal prongs than in patients with transtracheal oxygen delivery. Oxygen-conserving devices are reliable and advisable methods for nocturnal oxygenation.
-
Piston driven volume-cycled home ventilators increase work of breathing in the synchronized intermittent mandatory ventilation mode. A 2-year-old trisomy 21 patient with chronic lung disease due to recurrent aspiration pneumonia required a ventilator rate of 6-8 breaths per minute awake and 15 asleep, with peak pressure of 32 cm H2O and positive end-expiratory pressure (PEEP) of 10 cm H2O. Two circuits were designed to facilitate breathing and respiratory mechanics of his spontaneous breaths on both were compared. ⋯ The continuous positive airway pressure (CPAP) system provided continuous flow with a CPAP device set to deliver a pressure 2 cmH2O higher than the PEEP valve. On the CPAP system, compared to the reservoir system, dynamic compliance was greater [1.52 (0.14 SD) ml/cm H2O/kg vs. 0.39 (0.02), p < 0.001] and resistance less [8.15 (1.26) cm H2O/l/s vs. 45.86 (0.87), p < 0.001] as measured with a PeDS machine. This is an innovative use of a CPAP device.
-
Remarkable augmentation of breathing discomfort has been noted when ventilation is constrained to the steady state level during progressive hypercapnia. However, the effect of willful enhancement of ventilation on breathing discomfort remains to be evaluated. The present study examined the effects of moderate willful increases or decreases in ventilation during progressive hypercapnia on breathing discomfort in 12 subjects. ⋯ However, the sensational response did not change (6.3 +/- 0.8 vs. 5.8 +/- 0.7 mm/Torr). These rebreathing studies indicate that willful control of respiration decreases respiratory sensation even at comparable levels of ventilation. In particular, moderate willful increases in ventilation produce an ameliorating effect on the sensation of breathing discomfort.
-
We investigated the influence of low oxygen ventilation, air-bubble infusion into the pulmonary artery and their synergistic effect on pulmonary hemodynamics and microvascular permeability in isolated perfused rat lungs. Pulmonary arterial pressure was significantly increased by 70 min of ventilation with 3% O2 (hypoxia, group H); by 0.2-ml air-bubble infusion (pulmonary air embolism, group AE), and by 0.2-ml air-bubble infusion and 70 min of 3% O2 ventilation (hypoxia and pulmonary air embolism, group H & AE) compared with that of a control group (0.2 ml saline infusion, group C). Neither total (TPR) nor arterial (Ra) pulmonary vascular resistance in group H showed any difference compared to control values. ⋯ The pulmonary capillary fluid filtration coefficient, dry lung to wet lung weight ratio and white blood cell count in the perfusate of group H were not changed, while those of the groups AE and H & AE were significantly increased compared to those of controls. However, there was no significant difference in these values between groups AE and H & AE. Since hypoxia did not damage isolated perfused rat lungs, as determined by hemodynamics and permeability, nor enhance lung injury caused by air embolism, it was suggested that air embolism contributed more to high-altitude lung injury than low oxygen.