Chest
-
Comparative Study
Effect of body position on gas exchange in patients with unilateral central airway lesions. Down with the good lung?
In this study, we evaluated the effect of body position (erect, supine, and two decubitus positions) on gas exchange (alveolar-arterial PO2 difference [AaPO2]) in 35 patients who had various degrees of lung collapse roentgenographically caused by unilateral central airway lesions, with special reference to the difference in AaPO2 between two lateral decubitus positions. The patients were divided into two groups. Group 1 was composed of 23 patients with FEV1/FVC > 70 percent. ⋯ Unlike previous reports, the present study showed that AaPO2N was not exclusively less than AaPO2L in our patients. AaPO2N was higher than AaPO2L in 11 of 23 in group 1 and in 5 of 12 in group 2 patients. In summary, our results indicated that positional changes did not significantly affect gas exchange in the patients with lung collapse roentgenographically caused by unilateral central airway lesions and the dogma "Down with the good lung" could not be applied to these patients flawlessly.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Emergency department treatment of severe asthma. Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer.
To compare the effectiveness of administration of albuterol by nebulizer or by a metered-dose inhaler having a holding chamber attachment (hereafter "inhaler") for treatment of acute asthma in an emergency department (ED). ⋯ There was no detectable difference in effectiveness of albuterol administered by nebulizer or the inhaler system for treatment of acute asthma. There was no detectable difference in effectiveness of albuterol administered by nebulizer or the inhaler system for the treatment of acute asthma when the dose was titrated to clinical response. When compared with nebulizer, the metered-dose inhaler with holding chamber delivers a full dose of albuterol more quickly and at no higher cost.
-
Randomized Controlled Trial Clinical Trial
Reduced effect of inhaled beta 2-adrenergic agonists on lung mucociliary clearance in patients with cystic fibrosis.
It has been suggested that the defective cyclic AMP-dependent Cl- secretion and the increased Na+ absorption from airway epithelia in cystic fibrosis (CF) may lead to dehydrated secretions and impaired mucociliary clearance. Beta 2-adrenergic agonists are unable to stimulate the Cl- transport in the airways in CF while being able to do so in normal airways. Thus, we questioned whether the beta 2-adrenergic agonist, terbutaline, would improve mucociliary clearance in patients with CF as it does in healthy subjects. ⋯ We conclude that 1 mg of terbutaline did not improve mucociliary clearance significantly in the patients with CF. Also, the effect of terbutaline was much less than demonstrated earlier in healthy subjects. This is consistent with earlier findings of a lack of beta-adrenergic modulation of Cl- transport in CF. Thus, no rehydration of the dry mucus in CF is expected, and a possible beta 2-agonist-induced increase in ciliary beating would have only a minor effect on overall mucociliary clearance.
-
Advances in cytokine biology and molecular biology have led to the development of novel immunologic approaches to the treatment of septic shock, ARDS, and MOF. These advances are necessary since improvements in supportive care clearly fall short of the hoped-for reductions in mortality associated with these disorders. As noted in this review, these new therapies are directed at three distinct levels of the inflammatory cascade: (1) the inciting event or insult (eg, endotoxin); (2) the mediators (eg, TNF, IL-1); and (3) the effector cells (eg, neutrophils). ⋯ That is, due to the complexity and redundancy of the inflammatory network, it is doubtful that a "magic bullet" will be found. However, it is also clear that advances in our understanding of the pathogenesis of ARDS, septic shock, and MOF at the molecular level have provided clinicians with powerful weapons with which to do battle. It remains to be seen which ones will work the best.