Respiratory medicine
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Respiratory medicine · Sep 2006
Randomized Controlled TrialPhysiological response to intrapulmonary percussive ventilation in stable COPD patients.
Intrapulmonary percussive ventilation (IPV) is a ventilatory technique that delivers bursts of high-flow respiratory gas into the lung at high rates, intended for treating acute respiratory failure and for mobilization of secretions. We performed a study, aimed at assessing the physiological response to IPV, on patients' breathing pattern, inspiratory effort, lung mechanics and tolerance to ventilation. Ten COPD patients underwent randomized trials of IPV through a face mask at different pressure/frequency combinations (1.2 bar/250 cycles/min; 1.8/250; 1.2/350; 1.8/350), separated by return to baseline (SB), using the IMP2 ventilator. ⋯ Tolerance to ventilation and oxygen saturation were satisfactory and did not change during the different trials. In 5 normal subjects a prolonged apnea trial lasting > 2 min was also performed, without any significant decrease in SaO2 or subjective discomfort. In conclusion, IPV was able to guarantee an adequate ventilation, while inducing a significant unloading of the diaphragm during the "low-frequency" trials.
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Respiratory medicine · Sep 2006
Long-term moxifloxacin in complicated tuberculosis patients with adverse reactions or resistance to first line drugs.
To test safety and tolerability of long-term moxifloxacin in resistant tuberculosis (TB) patients and patients with intolerance to first line anti-TB drugs. ⋯ Despite the fact that a large proportion of patients experienced at least an AE due to moxifloxacin, the drug resulted safe in the long-term administration for complicated TB cases.
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Respiratory medicine · Aug 2006
Nasal continuous positive airway pressure with heliox in infants with acute bronchiolitis.
This is the first study aiming to assess the effects of heliox in combination with nasal continuous positive airway pressure (Hx-nCPAP) as a rescue treatment in infants with refractory acute bronchiolitis. Fifteen out of 78 infants with acute bronchiolitis consecutively admitted to PICU fulfilled the inclusion criteria: clinical score>or=5 or arterial oxygen saturation (SatO2)
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We evaluated an endobronchial valve device in the treatment of surgically created air leak or pneumothorax by eliminating antegrade flow. ⋯ Collapse of a selected lung segment with resolution of air leak can be achieved using bronchoscopically implanted valve device. The valve device may facilitate treatment of patients with post-surgical or post-traumatic persistent air leak.
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Respiratory medicine · Jul 2006
Titration of non-invasive positive pressure ventilation in chronic respiratory failure.
Non-invasive ventilation (NIV) is widely used for acute and chronic respiratory failure. If arterial blood gas tensions do not improve, the level of support can be increased. However, there may be a limit above which increasing ventilatory support leads only to greater interface leak with no improvement in ventilation. ⋯ There is debate about whether the therapeutic aim of NIV should be to reduce respiratory muscle effort, or to reverse nocturnal hypoventilation. We conclude that if the primary aim is to improve arterial blood gas tensions and this is not achieved, higher levels of ventilation can be obtained using greater pressure or volume, despite additional interface leak. If the aim is to abolish muscle effort completely, there is little to be gained by increasing the level of inspiratory pressure above 20 (CWD) or 25 (COPD) cm H(2)O.