Pneumologie
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Intrapleural administration of fibrinolytic agents has been in use for fifty years; it has, however, been of clinical importance only for the last twenty years. Parallel to clinical reports procoagulant and fibrinolytic activities in pleural effusions are studied. Most types of pleural injury are characterised by fibrin deposition in the pleural space promoted by concurrent local abnormalities of pathways of fibrin formation and its clearance. ⋯ On the basis of the data of literature we recommend to use a single daily dose of 250,000 U streptokinase or 100,000 U urokinase in 50-100 ml normal saline instilled into a chest tube and to maintain dwell times of 2 to 4 hours. Therapy can be continued up to 2 weeks. The pleural space can be drained by large bore chest tubes or small drainage catheters, both radiologically guided, without preference for one method.
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Clinical Trial
[Noninvasive pressure support ventilation (NIPSV) as therapy for severe respiratory insufficiency due to pulmonary edema].
Experimental use of noninvasive pressure support ventilation (NIPSV) in patients with severe pulmonary oedema who would have been intubated if noninvasive ventilation were not available. ⋯ NIPSV is a highly effective technique with which to treat patients with severe cardiogenic pulmonary oedema.
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Right ventricular dysfunction is common in patients with chronic obstructive pulmonary disease. Right ventricular function might be influenced by the afterload, which depends on pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR). To evaluate the influence of the right ventricular afterload on right ventricular performance, we investigated 30 patients with chronic obstructive pulmonary disease without clinical signs or history of left heart failure or coronary heart disease. ⋯ These patients showed no difference in afterload, blood gases or lung function-tests compared with the total group. In conclusion, right ventricular ejection fraction seems to be influenced by PVR and PAP which determinate the right ventricular afterload. The validity of the method depends on the severity of pulmonary hypertension, and hence measurement of RVEF might not provide a reliable estimation of pulmonary arterial pressure in patients suffering from mild to moderate pulmonary hypertension.