The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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After lung surgery, some patients complain of unexplained increased dyspnoea associated with hypoxaemia. This clinical presentation may be due to an interatrial right-to-left shunt despite normal right heart pressure. Some of these patients show postural dependency of hypoxaemia, whereas others do not. ⋯ Finally, the approach to closure of the foramen ovale or atrial septal defect is discussed. Open thoracotomy was the traditional approach in the past. Percutaneous closure has now become the most used and effective technique for the repair of the interatrial anatomical malformation.
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Based on prior data, the current authors hypothesised that beneficial pronation effects on gas exchange and respiratory mechanics might be maximised in severely hyperinflated chronic bronchitis patients. The current authors also sought to elucidate underlying mechanisms and to determine whether pronation effects are reflected by postural changes in inspiratory pressure-volume (P-V) curve characteristics. A total of 16 mechanically ventilated patients (for 16-36 h) with chronic bronchitis exacerbation were studied in pre-prone semirecumbent (SREC), prone and post-prone SREC postures. ⋯ In multiple linear regression, postural decreases in PEEPi,rs and additional lung resistance independently predicted postural decreases in lung LIP pressure and Pa,CO2), respectively. In conclusion, in severely hyperinflated patients, pronation reduces lung lower inflection point pressure and increases lung upper inflection point volume. Pronation effects on ventilation homogeneity and carbon dioxide arterial tension are maximised, implying that pronation can be useful during early controlled ventilation.
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Chronic obstructive pulmonary disease (COPD) is characterised by destruction of extracellular matrix (ECM) in parenchymal areas, whereas the bronchial walls can show fibrosis. In addition, an extensive inflammatory process is observed. CD8+ T-cells, located throughout the lung, and epithelial cells in centrally located airways, produce cytokines involved in the inflammatory process. ⋯ The current authors simulated the in vivo microenvironment using supernatants of CD3/CD28 stimulated CD8+ T-cells isolated from peripheral blood of COPD patients, supernatant of a bronchial-epithelial cell line, or a combination of both. The present data show that fibroblasts of chronic obstructive pulmonary disease patients display an altered response to the cytokine microenvironment, depending on both the disease stage and the central or peripheral location in the lung. Especially adhesion-related genes are upregulated in fibroblasts of chronic obstructive pulmonary disease patients, which can indicate a more pronounced role of fibroblasts in the inflammatory process in chronic obstructive pulmonary disease, possibly resulting in reduced function as effectors of extracellular matrix repair.
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Randomized Controlled Trial Comparative Study
High-intensity inspiratory muscle training in COPD.
The aim of the present study was to investigate the effects of an interval-based high-intensity inspiratory muscle training (H-IMT) programme on inspiratory muscle function, exercise capacity, dyspnoea and health-related quality of life (QoL) in subjects with chronic obstructive pulmonary disease. A double-blind randomised controlled trial was performed. Sixteen subjects (11 males, mean forced expiratory volume in one second (FEV(1)) 37.4+/-12.5%) underwent H-IMT performed at the highest tolerable inspiratory threshold load (increasing to 101% of baseline maximum inspiratory pressure). ⋯ H-IMT increased maximum inspiratory pressure by 29%, maximum threshold pressure by 56%, 6-min walk distance by 27 m, and improved dyspnoea and fatigue (CRDQ) by 1.4 and 0.9 points per item, respectively. These changes were significantly greater than any seen following S-IMT. In conclusion, high-intensity inspiratory muscle training improves inspiratory muscle function in subjects with moderate-to-severe chronic obstructive pulmonary disease, yielding meaningful reductions in dyspnoea and fatigue.
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Comparative Study
Evaluation of the user-friendliness of 11 home mechanical ventilators.
The home ventilator market has grown in size and complexity. The aim of this study was to determine if common home ventilators are user-friendly for trained intensive care unit (ICU) physicians. Eleven ventilator models were tested by 13 ICU physicians without practical experience in home mechanical ventilation. ⋯ The mean time for the most rapid of the physicians for all the tests was 58+/-53 s, compared with 15+/-9 s for the technician. In conclusion, trained intensive care unit physicians perform poorly when confronted with home mechanical ventilators without specific prior training. Therefore, it is hypothesised that the user-friendliness of home ventilators for other categories of users might be questionable.