Respiratory medicine
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To determine the causes, risk factors and complications of planned extubation failure of critically ill elderly patients, we conducted a prospective study of 175 consecutive patients (> or = 70 years old) admitted with respiratory failure. Thirty-six (21%) failed extubation within 72 h after planned extubation. Compared to a younger age group (< 70 years old) matched for severity of illness, inability to handle secretions (20%) was the most common reason of airway causes leading to extubation failure in the elderly while upper airway obstruction (22%) was the predominant cause in the control group. ⋯ After adjusting for severity of illness, elderly patients who required reintubation had a higher risk of developing nosocomial pneumonia. The presence of underlying pulmonary disease (odds ratio (OR), 2.9; 95% confidence interval (CI) 1.2-6.9), length of intubation > 4 days (OR, 4.3; 95% CI 1.8-10.2), and albumin levels < 2.5 g/dl (OR, 2.7; 95% CI 1.2-6.7) were independently associated with extubation failure in the old. Objective measurements of cough strength and secretion volume are needed to reduce the morbidity of elderly patients at risk for extubation failure.
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Respiratory medicine · Jul 2004
Comparative Study Clinical Trial Controlled Clinical TrialComparison of conventional nighttime with automatic or manual daytime CPAP titration in unselected sleep apnea patients: study of the usefulness of daytime titration studies.
Daytime CPAP titration studies with full polysomnography have been successfully performed in patients with severe sleep apnea-hypopnea syndrome (SAHS). The implementation of daytime studies in unselected SAHS patients could help to reduce the waiting lists for CPAP titrations. The main purpose of this study was to compare the effectiveness of conventional versus manual or automatic daytime CPAP titration in unselected patients with SAHS. ⋯ All groups showed similar decrease of sleepiness and hours of use of CPAP at 3 months of follow-up. Automatic and manual daytime PSG studies after sleep deprivation are useful for CPAP titration in unselected patients with SAHS. Pressure selected with AutoSet is significantly higher than with conventional daytime or nighttime titration, although not significant in terms of treatment compliance and symptom improvement.
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Respiratory medicine · Jul 2004
Multicenter StudyIs birth weight related to lung function and asthma symptoms in Nordic-Baltic adults?
Studies of birth characteristics and respiratory outcomes show contradictory findings. We wanted to investigate the association of birth weight with adult lung function as well as asthma symptoms while addressing the influence of demographic and environmental factors. Data was collected from the birth records of 1683 men and women born in 1947-1973 who were included in 6 Nordic-Baltic population samples investigated within the European Community Respiratory Health Survey (ECRHS). ⋯ After adjustment for birth length, gender, age, study centre, adult BMI, allergic rhinitis, parental and adult tobacco smoke exposure in multivariate regression analyses, birth weight was not associated with adult lung function or asthma symptoms. Further sub-sample analyses revealed no influence of gestational age, gender, age or geographical area. In this historic prospective cohort study an association was neither found between birth weight and adult lung function nor between birth weight and asthma symptoms.
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Respiratory medicine · Jul 2004
ReviewPulmonary function tests in preoperative pulmonary evaluation.
Pulmonary function testing (PFT) has been used to evaluate the risk for postoperative complications since the 1950s. PFT including spirometry, lung volumes, diffusing capacity, oximetry, and arterial blood gases has been used to assess the postoperative risk of lung resection. ⋯ We defined a new useful index, measured product (MP), to predict postoperative complications; MP had similar advantages of PPP. Since diffusing capacity at rest has been shown to be a good predictor of postoperative complications following lung resection, and since exercise testing has been also useful in preoperative evaluation prior to lung resection, we reasoned that evaluation of the effect of exercise on diffusing capacity would be helpful to evaluate the ability of the pulmonary capillary bed to expand and increase its capacity to transfer gas during exercise.
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Respiratory medicine · Jul 2004
Effect of exercise mode on oxygen uptake and blood gases in COPD patients.
Patients with chronic obstructive pulmonary disease (COPD) are characterised by decreased exercise tolerance, and, more variably, exercise induced hypoxaemia (EIH). Evaluation of physical work capacity and physiological responses to exercise may be performed by various procedures, but there are diverging opinions as to which exercise test should be preferred. In the current study, oxygen uptake and arterial blood gases in COPD patients have been compared during submaximal and maximal exercise on treadmill and ergometer bicycle. ⋯ Neither carbon dioxide output, ventilation, nor rate of perceived exertion (Borg RPE scale) showed significant differences between the two modes of exercise. The EIH during both maximal (delta Sa,O2 = -5.6+/-4.2 vs. -3.4+/-5.1%) and sub-maximal exercise was more pronounced during treadmill walking than during cycling. The present study indicates that the VO2peak in COPD patients is higher, the maximal lactate concentrations lower and the development of EIH more pronounced when exercise testing is performed on a treadmill than on a bicycle ergometer.