Respiration; international review of thoracic diseases
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Pleurodesis aims to obliterate the pleural space by producing extensive adhesion of the visceral and parietal pleura, in order to control relapse of either pleural effusions (mostly malignant) or pneumothorax. A tight and complete apposition between the two pleural layers is a necessary condition to obtain a successful pleurodesis, but--besides this mechanical aspect--there are many biological mechanisms that appear to be common to most of the sclerosing agents currently used. Following intrapleural application of the sclerosing agent, diffuse inflammation, pleural coagulation-fibrinolysis imbalance (favoring the formation of fibrin adhesions), recruitment and subsequent proliferation of fibroblasts, and collagen production are findings in the pleural space. ⋯ There is concern about complications (possibly associated with talc but other agents as well) related to systemic inflammation and possible activation of the coagulation cascade. In order to prevent extrapleural talc dissemination, large-particle talc is recommended. Although it could--to some degree--interfere with the mechanisms leading to pleurodesis and a carefully balanced clinical decision has therefore to be made, prophylactic treatment with subcutaneous heparin is recommended during hospitalization (immediately before and after the pleurodesis procedure).
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Comparative Study
What does built-in software of home ventilators tell us? An observational study of 150 patients on home ventilation.
Recent home ventilators are equipped with built-in software which provides data such as compliance, estimations of leaks, tidal volume, minute ventilation, respiratory rate, apnea and apnea-hypopnea indexes, and percentage of inspirations triggered by the patient (or ventilator). However, for many of these variables, there is neither consensus nor documentation as to what is to be expected in a population of stable patients under noninvasive ventilation (NIV). ⋯ Built-in software of home ventilators provides the clinician with new parameters, some of which are a useful adjunct to recommended tools for monitoring NIV and may contribute to a better understanding of residual hypoventilation and/or desaturations. However, an independent validation of the accuracy of this information is mandatory.
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Comparative Study
Clinical features and outcome of acute exacerbation of interstitial pneumonia: collagen vascular diseases-related versus idiopathic.
Relatively little is known about acute exacerbation (AE) of interstitial pneumonia associated with collagen vascular diseases (CVD-IPs). ⋯ Clinical features and outcome in AE of CVD-IPs were similar, if not identical, to those of IIPs, having a significant impact on the clinical course. AE of advanced IPF with typical radiologic features seems to have higher mortality compared with other forms of IP.
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Comparative Study
Acute exacerbation of idiopathic pulmonary fibrosis: outcome and prognostic factors.
Acute exacerbation is a substantial cause of death in patients with idiopathic pulmonary fibrosis with poorly described prognostic factors. ⋯ Acute exacerbations of idiopathic pulmonary fibrosis are more frequent during winter and spring. The time between admission and initiation of treatment is a new reported prognostic factor that should be investigated further. This finding highlights the need for a fast diagnostic approach that should probably be standardized. Early gas exchange modifications reflect the response to treatment and predict the prognosis.
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Randomized Controlled Trial
The effects of controlled breathing during pulmonary rehabilitation in patients with COPD.
Conventional pulmonary rehabilitation programs improve exercise tolerance but have no effect on pulmonary function in patients with chronic obstructive pulmonary disease (COPD). The role of controlled breathing using respiratory biofeedback during rehabilitation of patients with COPD remains unclear. ⋯ In patients with COPD undergoing a pulmonary rehabilitation program, controlled breathing using respiratory biofeedback has no effect on exercise capacity, pulmonary function, quality of life or cardiac autonomic function.