Respiratory medicine
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Respiratory medicine · Feb 1998
Haemodynamic response during initiation of non-invasive positive pressure ventilation in COPD patients with acute ventilatory failure.
The aim of this study was to check non-invasively the acute haemodynamic effects of non-invasive positive pressure ventilation (NPPV) initiation in patients with chronic obstructive pulmonary disease (COPD) and acute ventilatory failure (AVF). Nineteen consecutive COPD patients with AVF were evaluated clinically and echocardiographically during spontaneous breathing with O2 supplementation and during NPPV plus O2. NPPV was administered with a scheduled inspiratory pressure of 15 cmH2O and an expiratory pressure of 4 cmH2O, via facial mask. ⋯ It was concluded that the initiation of NPPV by facial mask does not alter haemodynamics acutely in most COPD patients with AVF, but individual patients may experience reduction in CO in spite of adequate oxygen saturation levels. This suggests that caution should be used when applying pre-determined and fixed pressures during NPPV. Monitoring haemodynamics by Doppler echocardiography may be useful for early detection of haemodynamic alterations due to NPPV application in patients with AVF.
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Respiratory medicine · Feb 1998
Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure.
Continuous positive airway pressure (CPAP) is the most widely used therapy for obstructive sleep apnoea (OSA). Despite its general efficacy, oxygen desaturation due to hypoventilation persists in some patients. The present study analysed the factors which are associated with this primary failure and, moreover, examined the effect of a bilevel positive airway pressure (BiPAP) trial. ⋯ In conclusion, patients with OSA resistant to initial CPAP are morbidly obese with impaired awake blood gas values. The percentage of time spent at < 90% of nocturnal SaO2 is independently associated with initial failure of CPAP. BiPAP in the control mode is adequate for nocturnal ventilation, and improves awake blood gas values.
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Respiratory medicine · Nov 1997
Comparative StudyPulmonary function after coronary artery bypass surgery.
Coronary artery bypass graft surgery (CABG) adversely affects pulmonary function tests (PFTs). Although several previous studies have addressed these changes, none has measured the forced vital capacity (FVC) on a daily basis. The purpose of the present study was to assess serial changes in the FVC following CABG and to identify factors that may influence these changes. ⋯ The nadir of FVC occurs immediately after surgery and improves gradually thereafter. However, on the tenth postoperative day, the FVC still remains more than 30% below pre-operative values. Since there is only a slight tendency for patients undergoing IMA grafting to have larger decreases in their pulmonary function, patients with ventilatory impairment should not be excluded from IMA grafting.
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Respiratory medicine · Oct 1997
ReviewPropofol for sedation in the intensive care unit: essentials for the clinician.
Propofol is a short-acting intravenous anesthetic commonly utilised in the intensive care unit (ICU) for sedation of mechanically ventilated patients. The rapid onset and termination of action make it an attractive drug for use in the ICU. ⋯ However, there are potential adverse reactions associated with the drug. This review discusses the pharmacology, administration and adverse effects associated with propofol with which clinicians who administer propofol should be familiar.
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Respiratory medicine · Sep 1997
Case ReportsMultiple tracheal strictures following mechanical ventilation.
Patients presenting with features of airway narrowing (cough, wheeze, exertional breathlessness and obstructive spirometry) may be suffering from either localized or generalized airway obstruction. Doctors sometimes overlook the possibility of localized obstruction (whether due to tumour, foreign body aspiration or stenosis), and patients may experience symptoms for a long time before the correct diagnosis is made.