Respiratory medicine
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Respiratory medicine · Jul 2008
Multicenter StudyNebulisers or spacers for the administration of bronchodilators to those with asthma attending emergency departments?
Systematic reviews and national guidelines conclude that the nebulised route of administration of bronchodilators has no advantage over the use of a spacer in moderately severe exacerbations of asthma. Whether this recommendation is implemented and whether it might affect use of staff time is unknown. ⋯ Spacer administration of bronchodilators to those with asthma attending EDs utilises less treatment time than use of a nebuliser. A survey of EDs in Greater London has shown that despite guideline conclusions there appears to be little evidence of reduction in use of nebulisers; a fear that use of alternatives might take nurses longer is not supported by this study.
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Respiratory medicine · Jul 2008
Randomized Controlled TrialBenzodiazepine and opioid sedation attenuate the sympathetic response to fiberoptic bronchoscopy. Prophylactic labetalol gave no additional benefit. Results of a randomized double-blind placebo-controlled study.
Hypertension and tachycardia are common during fiber-optic bronchoscopy (FOB), and this may lead to cardiac ischemia. The prophylactic addition of a beta-adrenergic anatagonist might mask this response and prevent the deleterious cardiovascular effects of FOB. ⋯ Patients undergoing FOB under adequate midazolam-alfentanil sedation do not develop excessive sympathetic drive that may lead to cardiac stress. The addition of labetalol did not confer additional benefit or risk to the patients. (ClinicalTrials.gov number, NCT00394537).
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Respiratory medicine · Jul 2008
ReviewEmerging paradigms in the management of malignant pleural effusions.
Malignant pleural effusions (MPE) are a common clinical problem in patients with neoplastic disease. The development of MPEs in advanced malignancies can cause significant morbidity and mortality. ⋯ Despite multiple new therapies placement of chest tube with sclerotherapy remains the standard of care. The purpose of this article is to review the emerging therapeutic options for MPE management.
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Respiratory medicine · Jul 2008
Multicenter StudyTime to desaturation in the 6-min walking distance test predicts 24-hour oximetry in COPD patients with a PO2 between 60 and 70mmHg.
The 6-min walking distance (6MWD) test is a useful tool for assessing patients with chronic obstructive pulmonary disease (COPD), but little is known about the changes in oxygen saturation that occur during the test. ⋯ The time to desaturation in the 6MWD test can discriminate early desaturators who desaturate during their daily living activities and late desaturators who do not desaturate. Ambulatory oximetry would thus only be necessary in patients with a time to desaturation that ranges between 1 and 3'30''.
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Respiratory medicine · Jul 2008
Randomized Controlled TrialEffects of inspiratory muscle thixotropy on the 6-min walk distance in COPD.
Thixotropy conditioning of inspiratory muscles at lower lung volumes decreases functional residual capacity (FRC) of following breath cycles with increases in inspiratory capacity. It remains uncertain whether this conditioning would improve exercise tolerance in chronic obstructive pulmonary disease (COPD). Sixteen male stable COPD patients with mild to severe airway obstruction participated. ⋯ Percentage predicted FRC correlated positively with differences in the 6MWD between control and after the thixotropy conditioning maneuver (r=0.78, P=0.007), whereas percentage predicted forced expiratory volume in 1s or the BODE index did not correlate with differences in the 6MWD (P>0.05). Thixotropy conditioning increases self-paced walking distance in patients with COPD. Patients with higher resting FRC benefited more from the conditioning with greater walking distance.