Clinics in chest medicine
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Clinics in chest medicine · Jun 1994
ReviewThe role of cardiopulmonary exercise testing in lung and heart-lung transplantation.
Cardiopulmonary exercise testing in recipients of lung and heart-lung transplants demonstrates significant restoration of exercise tolerance to individuals severely disabled by their underlying cardiopulmonary disease. Recipients can perform moderate levels of activity compatible with a normal lifestyle. Considerable exercise limitation, however, remains in most recipients as measured by maximum oxygen uptake and work rate, despite substantial improvement and often normalization in resting cardiopulmonary function. ⋯ Peripheral factors limiting exercise (which may include abnormalities in the peripheral circulation and peripheral neuromuscular structure and function) are almost universally seen and are probably the primary determinant of exercise limitation in these patients. At present, the relative contributions of various peripheral factors to exercise limitation are unclear. Further study may help elucidate these issues.
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To understand why someone is dyspneic during exercise, we need to follow the advice of Sir Francis Bacon: "No natural phenomenon can be adequately studied in itself alone, but to be understood must be considered as it stands connected with all of nature." In the present context, this implies the careful measurement of events related to metabolism, circulation, and respiration and of the associated sensory events as these systems adapt to the strain and stress of exercise.
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Clinics in chest medicine · Jun 1994
ReviewRole of exercise stress testing in preoperative evaluation of patients for lung resection.
Patients with diagnosed or suspected lung cancer first require appropriate staging and proven anatomic resectability. Excellent pre-operative spirometric data (FEV1 > 2.0 L, > 60% predicted) should recommend the patient for surgery immediately without further testing. Those whose preoperative FEV1 is less than 60% predicted or whose DLCO is less than 60% predicted should be sent for quantitative lung scanning to estimate postoperative spirometry and diffusing capacity. ⋯ Those who do not meet these criteria, however, should not be summarily refused surgery if they are willing to accept the possibility of an earlier death or prolonged disability over the certainty of a cancer-related death in the foreseeable months ahead. Because the lung scan prediction of postoperative regional physiology and the exercise test of global oxygen transport examine different aspects of physiologic operability, we would not disagree with anyone who would advocate doing both tests in those at high risk by virtue of spirometric criteria. The logic of this combined approach is illustrated by Figure 1.
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The first priorities in treating the patient with massive hemoptysis are to maintain the airway, optimize oxygenation, and stabilize the hemodynamic status. The major question to be answered is whether or not the patient should be intubated for better gas exchange, suctioning, and protection from sudden cardiorespiratory arrest. If the bleeding site is known, the patient should be placed with the bleeding lung in the dependent position. ⋯ Little data are available to assist in this decision, even for specific diseases, such as bronchiectasis. Similarly, the long-term course of patients treated with endobronchial tamponade or topical therapy is unknown. For patients with inoperable disease, limited reserve, or bilateral progressive disease, embolization frequently controls bleeding for prolonged periods.(ABSTRACT TRUNCATED AT 400 WORDS)
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Clinics in chest medicine · Mar 1994
ReviewRespiratory failure as a result of drugs, overdoses, and poisonings.
When taking care of critically ill patients, it is paramount to consider all factors that could be contributing to their illness. Even in this brief discussion, it is clear that numerous drugs, procedures, and ingestants are associated with acute respiratory failure from a variety of mechanisms and that a review of all possible drug/poison exposures needs to be done for every patient.