Respiratory medicine
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Respiratory medicine · Nov 2013
Randomized Controlled Trial Comparative StudyPhysiologic response to various levels of pressure support and NAVA in prolonged weaning.
Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation wherein the delivered assistance is proportional to diaphragm electrical activity (EAdi) throughout inspiration. We assessed the physiologic response to varying levels of NAVA and pressure support ventilation (PSV) in 13 tracheostomised patients with prolonged weaning. Each patient randomly underwent 8 trials, at four levels of assistance either in PSV and NAVA. i - high (no dyspnoea and/or distress); iv - low (associated with dyspnoea and/or distress; ii and iii - at ∼75% and ∼25% of the difference between high and low support respectively. ⋯ VT variability significantly increased when reducing ventilatory assistance in PSV only, while remained unchanged varying the NAVA level. The ineffective triggering index was not significantly different between the two modes. In patients with prolonged weaning, with the specific settings adopted, compared to PSV, NAVA reduced the risk of over-assistance and overall improved patient-ventilator interaction, while not significantly affecting patient-ventilator synchrony.
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Respiratory medicine · Nov 2013
Influence of radiological emphysema on lung function test in idiopathic pulmonary fibrosis.
Idiopathic pulmonary fibrosis (IPF) is one of the most frequent interstitial lung disease. Emphysema can be associated with IPF as described in the «Combined pulmonary fibrosis and emphysema» syndrome. ⋯ Radiological emphysema associated with IPF had an impact on pulmonary function tests. Despite this difference, the du Bois score was not statistically different between these two groups. Nevertheless, after one year of follow up, the patients with emphysema were in a subclass with a lower mortality rate than those without emphysema.
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Respiratory medicine · Nov 2013
Referral to palliative care in COPD and other chronic diseases: a population-based study.
To describe how patients with COPD, heart failure, dementia and cancer differ in frequency and timing of referral to palliative care services. ⋯ Patients with COPD are underserved in terms of palliative care compared to those with other chronic life-limiting diseases. Awareness of palliative care as an option for patients with COPD needs to increase in palliative care services, physicians and the general public.
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Respiratory medicine · Nov 2013
Case ReportsSevere adenovirus pneumonia requiring extracorporeal membrane oxygenation support--Serotype 7 revisited.
Adenovirus causing severe fatal pneumonia has been well described in infants, children, and patients with immunocompromised function, but reports in previously healthy adults are rare. We report 3 cases of severe adenovirus pneumonia in whom conventional mechanical ventilation failed and required extracorporeal membrane oxygenation support. ⋯ The mainstay of treatment for patients with severe adenovirus pneumonia is still supportive, with the use of antivirals not apparently effective. Whilst ECMO support for rescue ventilation may be considered, the outcomes do not appear as promising as other viral pneumonias, mirroring that previously described in the paediatric population.
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Patients with Chronic Obstructive Pulmonary Disease (COPD) have been shown to experience significant pain that interferes with their daily activities and quality of life. The purpose of this study was to examine if pain is associated with functional exercise capacity (assessed with the six-minute walk test, 6MWT), physical activity (assessed by accelerometry), and muscle performance (maximal knee extensor torque) in people with COPD. ⋯ Pain in patients with COPD is associated with low functional exercise capacity, reduced physical activity, and high BMI. Pain can adversely affect physical activity and quality of life in patients with COPD. Early evaluation of pain needs to be considered in the assessment and treatment plan for people with COPD.