The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
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Clinical Trial
A simple breathing circuit minimizing changes in alveolar ventilation during hyperpnoea.
Many clinical and research situations require maintenance of isocapnia, which occurs when alveolar ventilation (V'A) is matched to CO2 production. A simple, passive circuit that minimizes changes in V'A during hyperpnoea was devised. It is comprised of a manifold, with two gas inlets, attached to the intake port of a nonrebreathing circuit or ventilator. ⋯ Increases in fR did not significantly affect arterial CO2 tension (Pa,CO2) (p=0.28, ANOVA). Only the highest VT decreased Pa,CO2 from control (-0.5 +/- 0.3 kPa (-3.4 +/- 2.3 mmHg), p<0.05). In conclusion, this circuit effectively minimizes changes in alveolar ventilation and therefore arterial carbon dioxide tension during hyperpnoea.
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Case Reports
Central sleep apnoea in congestive heart failure despite vagal denervation after bilateral lung transplantation.
Nonhypercapnic central sleep apnoea is a disorder of respiratory control characterized by hyperventilation previously attributed to the stimulation of either pulmonary vagal afferent nerve fibres or respiratory chemoreceptors. This report describes central sleep apnoea in a patient with congestive heart failure following bilateral lung transplant in whom pulmonary vagal afferent nerve activity was absent.
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The objective of this study was to increase our understanding of the importance of members of the Streptococcus milleri (SM) group as respiratory pathogens, by studying the epidemiological and clinical features of thoracic infections caused by this group and comparing the epidemiology and prognosis of empyema caused by SM with cases of pneumococcal aetiology. The clinical histories and microbiology reports were reviewed in 27 cases of thoracic infection caused by SM over a period of 8 yrs. Cases of pneumococcal empyema that occurred during the same period were also analysed. ⋯ In conclusion, thoracic infections caused by Streptococcus milleri are largely pleural. They are polymicrobial in one-third of cases, commonly acquired in hospital and, in most patients, associated with major surgery and/or surgical procedures of the respiratory or digestive tract. The empyema frequently requires thoracotomy for complete resolution.
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Comparative Study
Drug output from nebulizers is dependent on the method of measurement.
The objective of this study was to determine whether current regulatory methods for assessing the output of nebulizers are appropriate for the delivery of nebulized steroid suspensions to patients. We studied a conventional jet nebulizer (the Intersurgical Cirrus), an open-vent nebulizer (the Medicaid Sidestream) and a breath-enhanced nebulizer (the Pari LC Plus), using a constant sampling flow or a sinusoidal pump to represent the breathing pattern of children from 6 months to adulthood. Recovery of budesonide released from the nebulizers onto filters was reduced when using breathing simulation compared with constant flow, and this reduction was greatest for the conventional nebulizer (Cirrus, 103 microg with constant flow to 4.4 microg with a 50 mL tidal volume; Pari, 176 microg to 25 microg). ⋯ The output of the LC plus was reduced at high flow, from 176 microg at 20 L x min(-1) to 93 microg at 60 L x min(-1). Overall, the measured output varied by up to 700%, depending on the method used. These results suggest that breathing patterns dramatically alter the measured output of different nebulizers and that breathing simulation should be included as part of their assessment.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Efficacy and safety of levodropropizine and dihydrocodeine on nonproductive cough in primary and metastatic lung cancer.
Nonproductive cough is a frequent and distressing symptom in patients with lung cancer, and it is not even relieved by palliative chemotherapy. A double-blind, randomized clinical trial regarding the treatment of nonproductive cough was performed in 140 adults with primary lung cancer or metastatic cancer of the lungs. The therapeutic efficacy and the tolerability of a 7-day treatment with levodropropizine drops (75 mg t.i.d.) were evaluated in comparison with dihydrocodeine drops (10 mg t.i.d.; 7 days). ⋯ The number of patients reporting adverse events was similar in the levodropropizine (n=6) and dihydrocodeine (n=4) group. However, the percentage of patients experiencing somnolence in the group receiving levodropropizine (8%) was significantly lower as compared with that of the dihydrocodeine group (22%). These results confirm the antitussive effectiveness of levodropropizine and suggest a more favourable benefit/risk profile when compared to dihydrocodeine.