Clinics in chest medicine
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Clinics in chest medicine · Dec 1988
ReviewBronchiolitis obliterans and airways obstruction associated with graft-versus-host disease.
Bronchiolitis obliterans is a nonspecific pathologic lesion seen after fume inhalation and infections, which is associated with connective tissue disorders and is a complication of organ transplantation. Bronchiolitis obliterans with organizing pneumonia is also associated with the connective tissue disorders but is usually idiopathic and has better prognosis with corticosteroid therapy. Bone marrow-related obliterative bronchiolitis is limited to patients who develop chronic graft-versus-host disease. ⋯ Bronchiolitis obliterans is the most important clinical complication in heart-lung transplant recipients. It is not preceded by typical features of chronic graft-versus-host disease, but has the same clinical course of dyspnea, airflow obstruction, and poor response to therapy. Bronchiolitis obliterans in transplant recipients may represent a form of allograft rejection.
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Clinics in chest medicine · Mar 1988
Review Historical ArticleThe modern evolution of mechanical ventilation.
Continuous mechanical ventilation used for life support is accepted as standard practice in nearly every hospital in the United States today. The history of the evolution of techniques that we take virtually for granted today is fascinating. This article recounts some of the highlights in the development of modern-day mechanical ventilators, with emphasis on the past 25 years.
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More than 150 years have passed since the birth of the idea of intermittent mechanical ventilation. Many types of ventilatory disorders can result in excessive loading of the respiratory muscles, thus causing them to fail. ⋯ Much more study is needed to determine the optimal times for respiratory muscle rest. Future technologic designs for ventilatory systems should aim to decrease cost and increase efficiency, ease of use, and durability.
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The vast majority of patients who undergo mechanical ventilation are able to discontinue ventilatory assistance within a few days. Typically, patients who require only short-term mechanical ventilation do not have severe underlying lung disease, and the problem for which they require ventilatory support is most commonly rapidly reversible. In these patients on short-term ventilatory support, parameters of spontaneous ventilatory requirements and respiratory muscle strength, including minute ventilation, maximal voluntary ventilation, vital capacity, and maximal inspiratory pressure, are useful in predicting the success of discontinuation of mechanical ventilation. ⋯ Adverse factors relevant to each of these mechanisms must be addressed and corrected to whatever extent possible. Studies have not demonstrated the superiority of either classic T-piece weaning or IMV weaning methods in difficult-to-wean patients on long-term ventilatory support. Both techniques may be used successfully as long as all patient variables that may adversely affect weaning ability are corrected or optimized and close care and attention to the details of the weaning process itself are provided.(ABSTRACT TRUNCATED AT 400 WORDS)
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Clinics in chest medicine · Dec 1987
ReviewEvaluation and stabilization of the critically ill child.
Because the timely treatment of children in accidents or with serious illnesses usually is successful, it is vital that the life-threatening problem promptly be recognized. Although the principles of resuscitation are identical in the child and adult, age-related differences in anatomy and pathophysiology may make this task challenging for the physician who usually cares for adults. In this article, a systematic approach to evaluation and initial stabilization of the pediatric patient is discussed. Decisions and methods in safely transferring a critically ill pediatric patient are also reviewed.