Respirology : official journal of the Asian Pacific Society of Respirology
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Hyperinflation with a decrease in inspiratory capacity (IC) is a common presentation for both unstable and stable COPD patients. As CPAP can reduce inspiratory load, possibly secondary to a reduction in hyperinflation, this study examined whether CPAP would increase IC in stable COPD patients. ⋯ The best individualized CPAP can increase inspiratory capacity in patients with stable COPD, especially in those with emphysema.
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A case of severe Legionella pneumonia was successfully treated by independent lung ventilation (ILV) with intrapulmonary percussive ventilation (IPV). A 57-year-old man with lobar pneumonia was intubated and mechanically ventilated because of his deteriorating respiratory status. The diagnosis of Legionella pneumonia was made on the fourth day after admission and appropriate antibiotic therapy was commenced. ⋯ On the tenth day after admission, ILV was changed to conventional bilateral ventilation. The patient was extubated on the sixteenth hospital day and discharged from the intensive care unit 30 days after admission. The combination of ILV and IPV was therapeutically effective during the acute phase of unilateral severe Legionella pneumonia.
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Ventilator-induced lung injury (VILI) leads to airway epithelial cell apoptosis and lung inflammation. High tidal volume ventilation in vivo has been shown to induce MIP-2 production, lung neutrophil sequestration and apoptotic airway cell death. This study aimed to determine the effect of N-acetylcysteine (NAC), a scavenger of oxygen radicals, on lung inflammation and apoptosis in an in vivo model of VILI. ⋯ These data point to an early role of oxidant-induced inflammation and apoptosis in VILI.
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Differences in central airway wall structure in patients with various forms of expiratory central airway collapse can be identified by endobronchial ultrasound using a 20 MHz radial probe. In tracheobronchomalacia due to relapsing polychondritis, the cartilage is thick and irregular while the membranous portion is normal. ⋯ In excessive dynamic airway collapse associated with COPD, on the contrary, the cartilage is normal and the posterior membrane is thin when compared to the normal airway wall structures identified in a patient with physiological dynamic airway collapse. These findings may support the hypothesis that various clinical forms of expiratory central airway collapse are not only different morphologically, physiologically and aetiologically, but also structurally.