Respiratory medicine
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Respiratory medicine · Jul 1995
Eradication of contaminating Mycobacterium chelonae from bronchofibrescopes and an automated bronchoscope disinfection machine.
The results of a follow-up study concerning the decontamination of Mycobacterium chelonae subspecies abscessus from the bronchofibrescopes and the automated bronchoscope disinfection machine are described in this paper. After modification of the methods for disinfecting the bronchofibrescopes (adding a disinfection procedure with 70% alcohol before using the automated bronchoscope disinfection machine, increasing glutaraldehyde concentration to 3%, and changing the glutaraldehyde solution once a week), and the automated bronchoscope disinfection machine (recirculating used disinfectant), M. chelonae has not been detected from either the bronchofibrescopes or the automated bronchoscope disinfection machine (examined every 6 months for 4 yr by microscopy and cultures). Moreover, no M. chelonae has been clinically detected from bronchial washings for 4 yr.
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Respiratory medicine · Apr 1995
Randomized Controlled Trial Clinical TrialEffect of body position on gas exchange in patients with unilateral pleural effusion: influence of effusion volume.
The objective of this study was to evaluate the effect of lateral body position on gas exchange in patients with unilateral pleural effusion, with special reference to the influence of effusion volume. Thirty consecutive patients with unilateral pleural effusion, without evidence of parenchymal pulmonary involvement, were entered into the study. Arterial blood gas tensions (PaO2, PaCO2) were randomly measured in both right and left lateral decubitus body positions, while breathing room air. ⋯ Mean PaO2 with the normal-side (control) down (PaO2-N) (81.4 +/- 8.5 mmHg) was higher, but without significant statistical difference, than mean PaO2 with the effusion-side down (PaO2-E) (78.0 +/- 12.5 mmHg). PaO2-N was higher than PaO2-E in 22 of 30 patients (conventional), and lower in eight patients (paradoxical). No consistent relationship was found for alterations in PaO2 in different positions with the volume of effusion, either when estimated by a roentgenographic method or when using spirometric or plethysmographic values.(ABSTRACT TRUNCATED AT 250 WORDS)
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Respiratory medicine · Mar 1995
Oxygen desaturation during sleep and exercise in patients with severe chronic obstructive pulmonary disease.
Patients with chronic obstructive pulmonary disease (COPD) have varying degrees of arterial oxyhaemoglobin desaturation during sleep, which have been shown to correlate with awake oxygen levels. We wished to ascertain if exercise desaturation was a better predictor of nocturnal oxygen desaturation than daytime blood gases. We studied 25 COPD patients with PaO2 < 10 kPa (mean = 8.6 kPa), 12 of whom were normocapnic (PaCO2 < or = 6 kPa, Group A), and 13 of whom were hypercapnic (PaCO2 > 6 kPa, Group B), by means of overnight oximetry and maximum treadmill exercise testing. ⋯ Awake SaO2 correlated well with both mean values (r = 0.7, P < 0.001), and minimum sleep SaO2 (r = 0.44, P < 0.05), but not with the fall in sleep SaO2 (r = 0.21, P = n.s.). Minimum sleep and exercise SaO2 were also significantly correlated (r = 0.44, P < 0.05), but the fall in SaO2 during sleep and exercise was not (P = n.s.). We conclude that exercise studies add no extra information to awake blood gas analysis in predicting the likelihood of nocturnal oxygen desaturation in patients with COPD.
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Respiratory medicine · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialSedation for fibre optic bronchoscopy.
Most current sedative regimens for fibre optic bronchoscopy use an opioid, a benzodiazepine or a combination of both. This study compares midazolam (M) (a benzodiazepine), alfentanil (A) (an opioid) and a combination of both drugs (M+A). One hundred and three patients were randomized in double-blind manner into groups M(35), A(33) and M+A(35). ⋯ There was a trend for Group M+A to desaturate more than the other two with a significant difference between desaturation in Group M+A and Group A (P = 0.033). Alfentanil is a more effective anti-tussive agent than midazolam for outpatient fibre optic bronchoscopy. The combination of alfentanil and midazolam does not provide any better anti-tussive effect and may have the risk of a greater degree of desaturation secondary to increased sedation.