Respiration; international review of thoracic diseases
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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.
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Varying degrees of impairment in pulmonary function in survivors of adult respiratory distress syndrome (ARDS) have been reported. Physiologic indices of the severity of disease have been associated with impaired pulmonary function after ARDS, including duration of exposure to FIO2 > 0.6, AaDO2, maximal mean pulmonary artery pressure, lowest total static thoracic compliance, and peak airway pressure. Prediction of impairment following ARDS is difficult because clinical observations may reflect reversible lung injury (e.g. lung edema) and clinical features of ARDS do not predict subsequent function reliably. ⋯ Significant correlations (p < 0.001) were found between linear regressions of percent predicted FEV1, FVC, TLC and DLCO against ARDSscore. ARDSscore > +20 predicted an 82% probability of impaired FEV1, FVC or TLC and a 100% probability of an impaired DLCO. We conclude that a score based upon duration of positive pressure ventilation and lowest static thoracic compliance predicts impaired pulmonary function more than 1 year after ARDS.
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Clinical appearance, radiologic findings, lung function and results of corticosteroid therapy were analyzed in 42 adult cases of biopsy-proven pulmonary histiocytosis X. Symptoms were present in only 64%. Using the ILO classification 1980, the evaluation of chest radiographs revealed all categories of profusion, size and shape of nodules. ⋯ Bronchial reactivity to carbachol was significantly higher than in controls (n = 12). Lung perfusion scintigram showed an abnormal, but uncharacteristic pattern in 81% (n = 26). During corticosteroid therapy, no progression was observed (n = 36). 85% of patients with radiographic evidence of progressive disease improved after administration of corticosteroids (n = 14).
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Asthma and chronic obstructive pulmonary disease (COPD) are complex conditions with imprecise definitions which make definitive morphological comparisons difficult. Broadly, the airways in asthma are occluded by tenacious plugs of exudate and mucus, there is fragility of airway surface epithelium, thickening of the reticular layer beneath the epithelial basal lamina and bronchial vessel congestion and oedema. There is increased inflammatory infiltrate comprising 'activated' lymphocytes and eosinophils with release of granular content in the latter, and there is enlargement of bronchial smooth muscle particularly in medium sized bronchi. ⋯ In small (peripheral) airways disease, there is inflammation of bronchioli, mucous metaplasia and hyperplasia, with increased intralumenal mucus, increased wall muscle, fibrosis and airway stenoses. Respiratory bronchiolitis is a critically important early lesion which may predispose to the development of centrilobular emphysema. The severity of destruction of alveolar wall in emphysema appears to be the most important determinant of chronic deterioration of airflow.
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Comparative Study
Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax.
In this prospective study, the value of computed tomography (CT) in detecting bullae and bleb formation of the lung in 35 patients with primary spontaneous pneumothorax (PSP) has been determined. The ability of CT in the detection of bullae and bleb formation and fibrotic changes is compared with the chest film in PSP. CT showed pathological lung changes in 31/35 patients. ⋯ Additionally, 2 recurrences occurred. No correlation between recurrences and anatomical status (number, size and distribution of blebs/bullae) as assessed by CT was found. Differential treatment protocols on the basis of the initial findings do not appear to be warranted.