Pneumologie
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Randomized Controlled Trial Clinical Trial
[Inhaled prostacyclin and iloprost in severe pulmonary hypertension secondary to pulmonary fibrosis].
Pulmonary hypertension is a life-threatening complication of lung fibrosis. Vasodilator therapy is difficult owing to systemic side effects and pulmonary ventilation-perfusion mismatch. We compared the effects of intravenous prostacyclin and inhaled NO and aerosolized prostacyclin in randomized order and, in addition, tested for effects of oxygen and systemic calcium antagonists (CAAs) in eight patients with lung fibrosis and pulmonary hypertension. ⋯ Long-term therapy with aerosolized iloprost (long-acting PGI2 analog) resulted in unequivocal clinical improvement from a state of immobilization and severe resting dyspnea in a patient with decompensated right heart failure. We concluded that, in pulmonary hypertension secondary to lung fibrosis, aerosolization of PGI2 or iloprost causes marked pulmonary vasodilatation with maintenance of gas exchange and systemic arterial pressure. Long-term therapy with inhaled iloprost may be life saving in decompensated right heart failure from pulmonary hypertension secondary to lung fibrosis.
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In many ICU's in these days non-invasive mask ventilation is a technique in addition to the traditional invasive ventilation via endotracheal tube if the patient is able to cooperate. If contraindication (mucus retention, swallowing disorders, acute neurologic disorders, circulatory instability) and definition of interruption criteria are regarded, the method is safe. ⋯ According to pathophysiologic pathways the use of non-invasive techniques seems limited to not-so-advanced stages of the disease in these cases. Considering the growing importance of this technique for the weaning procedure after long-term mechanical ventilation should be established at every ICU.