Respiratory medicine
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Respiratory medicine · Jan 2004
Review Practice Guideline GuidelineThe use of oxygen in the palliation of breathlessness. A report of the expert working group of the Scientific Committee of the Association of Palliative Medicine.
Dyspnoea is a common, distressing symptom and difficult to control with medical treatment. The role of oxygen in reducing the severity of the symptoms and improving quality of life is still unclear. A working party of the Association of Palliative Medicine Science Committee set out to examine the evidence concerning the use of oxygen for the palliation of breathlessness in COPD, advanced cancer and chronic heart failure and to make recommendations for clinicians working in palliative care. ⋯ There was no evidence available for heart failure, very little for advanced cancer and although there were a number of trials on the use of oxygen in COPD very few, until recently, used reduction of breathlessness as an outcome measure. Recommendations are made on the basis of the evidence available and expert opinion such as the Royal College of Physicians report on the use of domiciliary oxygen. Oxygen use has to be tailored to the individual and a formal assessment made of its efficacy for reducing breathlessness and improving quality of life for that person [corrected].
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Respiratory medicine · Jan 2004
Outcome of lung cancer patients with acute respiratory failure requiring mechanical ventilation.
To assess the weaning outcome of lung cancer patients with acute respiratory failure (ARF) requiring mechanical ventilation, we retrospectively analyzed the database of the respiratory intensive care unit at a university-affiliated tertiary care hospital. Charts were reviewed for cancer status, biochemistries before respiratory failure, causes of respiratory failure, acute physiology and chronic health evaluation (APACHE) III score, ventilatory settings, data recorded during spontaneous breathing, duration of ventilator days, and weaning outcome. Ninety-five consecutive respiratory failure events in 81 patients were recorded from January 1, 1995 through June 30, 1999. ⋯ Serum albumin level, APACHE III score, highest fractional inspired O2 (FiO2) and highest positive end-expiratory pressure, organ failure, ability to shift to partial ventilatory support, and duration of mechanical ventilation could significantly influence the weaning outcome statistically. The overall hospital mortality rate was 85.2%. Our results suggested that lung cancer patients with ARF will have a better chance to wean if the initial APACHE III score was less than 70, use of FiO2 never exceeded 0.6, or less than 2 additional organ systems failed during the treatment course.
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Tracheal and lung sounds measurements for clinical applications depends on their intrasubject repeatability. Our objectives were to characterize tracheal and lung sounds and to investigate the temporal variability in normal adults. Tracheal sounds were studied in 7 subjects and lung sounds in 10 adults. ⋯ We measured the frequencies below which 25% (F25), 50% (F median), 75% (F75) and 99% (SEF99) of the spectral power between 100 and 2000 Hz. There were no differences between the measurements obtained at different days comparing each subject (P = ns, ANOVA). Our results show that the spectral pattern of tracheal and lung sounds are stable with low intrasubject variability.
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Respiratory medicine · Dec 2003
Comparative StudyCardiac or pulmonary dyspnea in patients admitted to the emergency department.
A simple and quick way of discrimination between cardiac and pulmonary causes of dyspnea is essential in patients admitted to the emergency department. We aimed to assess the utility of easily applicable diagnostic tools in the differential diagnosis of cardiac and pulmonary causes of dyspnea in patients presenting with shortness of breath. Clinical and radiologic evaluation, peak expiratory flow (PEF), PaO2, PaCO2 measurements were performed in 94 patients admitted to the emergency room with dyspnea. ⋯ Also for pulmonary dyspnea, sensitivity and specificity values for PaCO2 were 50% and 93%. We conclude that DDI, %DDI, PEF, %PEF, PaO2 and PaCO2 are simple and easily applicable tools for differential diagnosis of cardiac and pulmonary dyspnea. Adjunctive utility of these tests in the emergency department with clinical and radiologic evaluation contributes to this discrimination.
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Respiratory medicine · Nov 2003
Randomized Controlled Trial Clinical TrialTopical tetracaine prior to arterial puncture: a randomized, placebo-controlled clinical trial.
The objective of this randomized, double-blind, placebo-controlled clinical trial was to determine whether a topical anesthetic agent (tetracaine) provides effective local analgesia prior to radial arterial puncture. Tetracaine or placebo gel was applied 45 min prior to arterial puncture to patients who were referred for elective arterial blood gas. The primary outcome was the patient's perception of pain associated with the procedure as measured by a visual analog scale. ⋯ Mean time from the first skin puncture to successful procurement of 1 ml of arterial blood was 70 +/- 103s in the tetracaine group and 49 +/- 48s in the placebo group (P = 0.40). Difficulty of arterial puncture as assessed by the respiratory therapist performing the test was identical for the two groups (P = 0.86). We conclude that tetracaine gel did not decrease patient's perception of pain associated with arterial puncture, nor did its use facilitate the ABG procedure.