Pneumologie
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Pulmonary complications are the most common causes of mortality in patients with severe inspiratory and/or expiratory muscle weakness. An inspiratory tidal volume below 1500 ml and a peak cough flow below 160 L/min result in mucus retention and increase the risk of pneumonia. An intact cough function is pivotal for airway clearance during acute and chronic airway infections with increased mucus production as well as for protection against endotracheal aspirations. ⋯ Non-invasive assistance of inspiration can be provided by manual hyperinflation, air stacking, glossopharyngeal breathing or mechanical insufflation. Safe and effective methods of expiration assistance include manual thorax and abdominal compression, manual self-assistance as well as mechanical insufflation-exsufflation. The use of these non-invasive inspiratory and expiratory muscle aids can decrease the risk of pulmonary complications in patients with severe ventilatory muscle weakness.
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The management of acute lung injury in adults requires specific therapeutic measures including techniques of extracorporeal lung support. In patients suffering from severe acute respiratory distress syndrome (ARDS) with life-threatening hypoxaemia, a pump-driven, veno-venous extracorporeal membrane oxygenation (ECMO) has been established. Recently, a pumpless extracorporeal lung support system was developed using an arterio-venous bypass into which a gas exchange membrane is integrated ("interventional lung assist" [iLA]). ⋯ In both techniques, an improvement in survival has not been demonstrated in prospective investigations. ECMO and iLA might be associated with serious complications (bleeding, ischaemia), thus further randomised prospective studies are warranted to elucidate specific indications. In patients with severe asthma or exacerbation of chronic obstructive pulmonary disease, iLA might represent an attractive rescue therapy in the future.
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Comparative Study
[Comparison of pulmonary compliance and the work of breathing with pulmonary function parameters in men].
Dynamic and static pulmonary compliance as well as the work of breathing are essential parameters for describing respiratory mechanics. However, current reference values or correlations with other pulmonary function variables have been established only in studies with small numbers of participants. Therefore, the aim of the present study was to compare pulmonary compliance and the work of breathing with different pulmonary function parameters in a large number of men. ⋯ Lung volumes are important for the interpretation of pulmonary compliance and the work of breathing and therefore have to be considered in the assessment of respiratory mechanics. In contrast, the work of breathing is essentially influenced by the airway resistance. With increasing age there is only a small decrease in pulmonary compliance and the work of breathing.