American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Mar 1997
PEEP and low tidal volume ventilation reduce lung water in porcine pulmonary edema.
This study analyzed the effect of both positive end-expiratory pressure (PEEP) and reduction in tidal volume (VT) on extravascular lung water (EVLW) in a permeability model of pulmonary edema. Immediately after producing a pulmonary edema with oleic acid, 21 pigs were randomized into three groups. Group I (n = 8): PEEP of 0 cm H2O (ZEEP), VT of 12 ml/kg; Group II (n = 6): PEEP of 10 cm H2O, VT of 12 ml/kg; Group III (n = 7): PEEP of 10 cm H2O, VT of 6 ml/kg. ⋯ EVLW-G was less in Group II than in Group I at 16.3 +/- 2.7 and 23.2 +/- 4.2 ml/kg, respectively (p < 0.0001), and less in Group III than in Group II at 10.7 +/- 0.9 and 16.3 +/- 2.7 ml/kg (p < 0.0001). We conclude that early application of 10 cm H2O of PEEP reduces EVLW in permeability pulmonary edema. The lowering of VT reduced EVLW even further.
-
Am. J. Respir. Crit. Care Med. · Mar 1997
Multicenter Study Clinical Trial Controlled Clinical TrialOutcomes of advance directive education of pulmonary rehabilitation patients.
We performed a two-site prospective, controlled interventional study of patients enrolled in pulmonary rehabilitation to assess effects of advance directive education on completion of (1) living wills, (2) durable powers of attorney for health care (DPAHC), (3) patient-physician discussions about advance directives, and (4) discussions about life support, in addition to (5) patient impressions that their physicians understood their end-of-life preferences. The educational group had an increase (p < 0.05) in all five study outcomes compared with baseline values; the control group had an increase in three of five outcomes. ⋯ The educational intervention was an independent explanatory factor by multivariate analysis. We conclude that patients enrolled in pulmonary rehabilitation are receptive to advance care planning, which is promoted by education on end-of-life issues.
-
Am. J. Respir. Crit. Care Med. · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of three oxygen delivery systems during exercise in hypoxemic patients with chronic obstructive pulmonary disease.
Oxygen therapy improves submaximal exercise tolerance in hypoxemic patients with chronic obstructive pulmonary disease (COPD). This study compared the standard nasal cannula, reservoir nasal cannula, and a demand flow device in 15 male hypoxemic patients with COPD. On six separate occasions each subject used, in a randomized order, all three systems while completing incremental cycle ergometry and a test circuit composed of tasks that simulate activities of daily living. ⋯ There was a trend toward lower Spo2 with the demand flow device (p = 0.103) during arm work above shoulder level. Although not statistically significant, reservoir nasal cannula use resulted in consistently lower tidal volume and minute ventilation during test circuit activities. Exercise tolerance was not significantly different between the three oxygen delivery systems.
-
Am. J. Respir. Crit. Care Med. · Mar 1997
ReviewGold-induced pulmonary disease: clinical features, outcome, and differentiation from rheumatoid lung disease.
Gold-induced pulmonary disease is difficult to diagnose, especially, in the case in which interstitial pneumonia appears in the course of gold therapy for rheumatoid arthritis. We analyzed the literature to define the clinical features and prognosis of gold-induced pulmonary disease, and to identify those features that distinguish gold-induced pulmonary disease from pulmonary disease secondary to the underlying disease process of rheumatoid arthritis. Relevant articles from the medical literature were identified using a Mediline search, and the bibliographies of the articles were retrieved. ⋯ Features that distinguish gold-induced pulmonary disease from rheumatoid lung disease include female predominance, presence of fever or skin rash, absence of subcutaneous nodules or finger clubbing, low titers of rheumatoid factor at onset of lung disease, lymphocytosis in bronchoalveolar lavage fluid (BALF), and alveolar opacities along the bronchovascular bundles on chest CT scan. Gold-induced lung disease is a distinct entity that can be distinguished from rheumatoid lung disease. It usually improves with cessation of therapy or treatment with corticosteriods.
-
Am. J. Respir. Crit. Care Med. · Mar 1997
Randomized Controlled Trial Clinical TrialNitrogen dioxide exposure enhances asthmatic reaction to inhaled allergen in subjects with asthma.
We investigated whether exposure to a low level (490 micrograms/m3) of nitrogen dioxide (NO2) affects bronchial responsiveness to allergen and enhances allergen-induced increase in airway responsiveness to histamine. Eighteen subjects with asthma and allergy to pollen were exposed at rest to either purified air or NO2 for 30 min followed 4 h later by an allergen inhalation challenge. Responsiveness to histamine was measured the day after. ⋯ NO2 effect on lung function was neither associated with an increase in eosinophil numbers nor with ECP levels. NO2 did not affect lung function before allergen challenge, early asthmatic reaction, and allergen-induced increase in responsiveness to histamine. These results indicate that short exposure to an ambient level of NO2 followed several hours later by allergen inhalation enhances allergen-induced late asthmatic reaction.