Pneumologie
-
Randomized Controlled Trial Comparative Study
[Efficacy of tiotropium bromide (Spiriva) in patients with chronic-obstructive pulmonary disease (COPD) of different severities].
Aim of this study was to evaluate the efficacy of inhaled Tiotropium bromide in COPD patients of different severities in pneumological practices during a three months clinical trial. ⋯ Tiotropium bromide 18 microg once daily led to a persistent improvement of lung function and a reduction of exacerbations in patients with COPD of different severities.
-
Until recently "mechanical ventilation" meant "intensive care unit (ICU)". Important arguments for more flexibility concerning the locality where patients are mechanically ventilated are the increase in number of patients, costs and reduced resources. ⋯ The RICU is the key player in this concept, since as a step down unit it represents a cost-effective approach to the care of substantial numbers of selected patients requiring specialized respiratory care, e. g. intensive respiratory monitoring and therapy, particularly those requiring prolonged mechanical ventilation and non-invasive mechanical ventilation. Success of the RICU requires an experienced team, adequate location and high quality of technical equipment, experienced team, adequate location and high quality of technical equipment.
-
Review
[Principles and function of mechanical ventilation: classification and modes of ventilators].
A spectrum of diseases is associated with the necessity for partial or total support of pulmonary ventilation. The insight into the function of ventilators and their modes reduces the spectrum of ventilatory support to a few basic principles. The knowledge enables the pulmonary intensivist to adapt mechanical ventilation to the individual patient's needs. This overview describes the technical aspects of mechanical ventilation and summarizes the variety of specific modes implied.
-
Mechanical ventilation is required if ventilatory insufficiency is present. This is typically indicated by hypercapnea. Hypoxemia occurs secondary to hypoventilation. ⋯ Assisted ventilation will result in improved gas exchange but only incomplete unloading of respiratory muscles and therefore delayed restitution. Permanent controlled ventilation under sedation for a prolonged period (days) requires intermittent periods of assisted- or spontaneous breathing in order to avoid atrophy of the respiratory muscles. This review summarizes background information on the nature of the derangement, the relation between oxygen supply and consumption under special consideration of respiratory muscle insufficiency and impact of different ventilation modes.
-
Pleural effusions of infectious origin usually present as a complication of pneumonia, or, more rarely, of thoracic surgical procedures. Treatment is based upon the clinical picture, the appearance of the pleural fluid, on certain laboratory parameters, and upon the success of therapeutic interventions. The initial antibiotic regimen should cover the causative organisms that may empirically be expected in the individual setting of the patient. ⋯ Loculated effusions that do not promptly improve after drainage can additionally be treated by a trial of intrapleural fibrinolysis for a period of approximately three days. However, the precise role of fibrinolytics in the setting of complicated pleural effusions and empyemas remains to be better defined. Early definitive surgical treatment, preferentially by video-assisted thoracoscopic surgery (VATS), should be the goal in all patients who do not promptly respond to drainage and/or intrapleural fibrinolytic therapy and who qualify for a surgical intervention.