Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Synchronized intermittent mandatory ventilation with and without pressure support ventilation in weaning patients with COPD from mechanical ventilation.
This prospective study compared two weaning modalities in COPD patients requiring mechanical ventilation (MV) for acute respiratory failure. Nineteen patients with COPD were studied when their precipitating illness was controlled. Although they satisfied the conventional bedside weaning criteria, they could not tolerate any reduction in the respirator rate below 10 cycles/min. ⋯ At each step, however, group 1 patients showed significantly higher spontaneous tidal volume and lower spontaneous breathing frequency than did group 2 patients. We found a slight but not significant tendency to a shorter weaning period with than without PSV, but no difference in the weaning success. We concluded that (1) conventional weaning criteria might be inaccurate in COPD patients, (2) SIMV appeared very useful in weaning COPD patients from MV, (3) PSV marginally reduced the weaning period when added to SIMV, and (4) the OCB was not significantly improved with PSV.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of low flow and high flow oxygen delivery on exercise tolerance and sensation of dyspnea. A study comparing the transtracheal catheter and nasal prongs.
We hypothesized that high flow transtracheal oxygen (HFTTO) will improve exercise tolerance as compared with low flow transtracheal oxygen (LFTTO) and that transtracheal oxygen (TTO) will increase exercise tolerance with less dyspnea as compared with nasal prongs (NP) at equivalent oxygen saturation (SaO2). ⋯ We conclude that the use of high-flow oxygen via both transtracheal catheter and NP significantly increased exercise tolerance in our COPD patients when compared to low-flow oxygen. Transtracheal oxygen did not increase maximum exercise tolerance with less dyspnea as compared with oxygen via NP at equivalent SaO2.
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Randomized Controlled Trial Clinical Trial
Respiratory muscle rest using nasal BiPAP ventilation in patients with stable severe COPD.
To more systematically evaluate the effect of respiratory muscle rest on indices of ventilatory function, nine outpatients with stable, severe COPD were treated with nasal pressure-support ventilation delivered via a nasal ventilatory support system (BiPAP, Respironics, Inc) for 2 h a day for 5 consecutive days. An additional eight control patients were treated with sham-BiPAP. Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), maximum voluntary ventilation (MVV), arterial blood gas values, Borg dyspnea score, dyspnea-associated functional impairment scales, and distance walked in 6 min were measured in subjects prior to and following the week-long trial. ⋯ Nasal BiPAP also increased distance walked in 6 min from 780 +/- 155 to 888 +/- 151 ft (p < 0.01) (23,400 +/- 4,650 to 26,640 +/- 4,530 cm) (p < 0.01), whereas sham-BiPAP had no effect (768 +/- 96 and 762 +/- 106 ft [23,040 +/- 2,880 and 22,860 +/- 3,180 cm]) before and after sham treatment, respectively). In conclusion, these results indicate that nasal pressure-support ventilation, delivered via nasal BiPAP, improves exercise capacity and reduces dyspnea over the short term in selected outpatients with stable severe COPD. Whether such short-term improvement can be sustained merits further study.
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The precise roles of fiberoptic bronchoscopy (FOB) and computed tomography (CT) of the chest in the evaluation of patients presenting with hemoptysis have not been clearly defined. On the assumption that both procedures would likely provide unique and complementary information, a prospective study with blinded interpreters using a modified high-resolution CT technique (HRCT) and FOB was designed to evaluate 57 consecutive patients admitted to Bellevue Hospital with hemoptysis. Etiologies included bronchiectasis (25 percent), tuberculosis (16 percent), lung cancer (12 percent), aspergilloma (12 percent), and bronchitis (5 percent): in an additional 5 percent of cases, hemoptysis proved to be due miscellaneous causes, while in 19 percent hemoptysis proved to be cryptogenic. ⋯ High-resolution CT proved of particular value in diagnosing bronchiectasis and aspergillomas, while FOB was diagnostic of bronchitis and mucosal lesions such as Kaposi's sarcoma. Fiberoptic bronchoscopy localized bleeding in only 51 percent of cases. The high sensitivity of CT in identifying both the intraluminal and extraluminal extent of central lung cancers in conjunction with its value in diagnosing bronchiectasis suggest that CT should be obtained prior to bronchoscopy in all patients presenting with hemoptysis.
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Outcome from cardiopulmonary resuscitation (CPR) at community hospitals is seldom reported in the literature. Data regarding long-term functional status of CPR survivors are virtually nonexistent. We retrospectively reviewed the medical records of all patients receiving CPR during 1989 at a community teaching hospital to determine survival to hospital discharge from CPR. ⋯ We believe survival from CPR at community teaching hospitals is comparable to university hospitals. Additionally, patients who survive in-hospital CPR to hospital discharge have a 54 percent chance of being alive a mean of 31 months postdischarge with most being able to live independently. Further work is needed to validate these long-term functional status results.