Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jul 2000
Comment Meta Analysis[Acute low back pain: activity, NSAID's and muscle relaxants effective; bedrest and targeted exercise not effective; results of systematic reviews].
To inventory the current state of the art regarding the effectiveness of conservative treatment of acute low back pain. ⋯ Approximately two-thirds of the randomised trials in the field of back pain were of poor methodological quality. There was strong evidence that advice to stay active, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants were effective in acute low back pain. There was also strong evidence that bed rest and specific exercises were not effective in acute low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.
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Ned Tijdschr Geneeskd · Jul 2000
Meta Analysis[Chronic low back pain: exercise therapy, multidisciplinary programs, NSAID's, back schools and behavioral therapy effective; traction not effective; results of systematic reviews].
To inventory the current state of the art regarding the effectiveness of conservative treatment of chronic low back pain. ⋯ There was strong evidence that exercise therapy and multidisciplinary treatment programmes were effective in chronic low back pain, and moderate evidence that non-steroidal anti-inflammatory drugs (NSAIDs), back schools and behavioural therapy were effective in chronic low back pain. There was also strong evidence that traction was not effective in chronic low back pain. Strong evidence for effectiveness of many other commonly used interventions was lacking.
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Critical-illness polyneuropathy and myopathy (CIPNM) can be considered a part of the syndrome of multiple organ dysfunction. CIPNM is the commonest cause of muscle weakness acquired in the intensive care unit. Its incidence is 35-80% during prolonged mechanical ventilation. ⋯ CIPNM may be induced by triggering of the immune response leading to increased vascular permeability with tissue invasion of inflammatory cells and local damage. There is a relation between myopathy and medication, notably corticosteroids. Clinical improvement usually follows when the CIPNM patient survives the underlying disease, but weaning from artificial ventilation is often difficult, and rehabilitation prolonged.
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Ned Tijdschr Geneeskd · Jul 2000
Case Reports[Hemodynamic and ventilatory complications of mechanical ventilation with high intrinsic positive end-expiratory pressure].
In three mechanically ventilated patients ventilatory and circulatory complications resulted from high levels of intrinsic positive end-expiratory pressure (PEEPi): progressive pulmonary hyperinflation due to impairment of the expiration. PEEPi was initially not considered as the cause of shock and low tidal volumes and/or high inflation pressures. In a 74-year-old man the circulation deteriorated further when hand bagging was started in an attempt to improve his ventilatory condition; after reduction of the respiration rate, he recovered well. ⋯ A 59-year-old woman developed acute exacerbation of severe chronic obstructive pulmonary disease, and went into shock during interhospital ambulance transport; she was stabilized after recognition of PEEPi and adjustment of the setting of the ventilator. Detection of PEEPi (e.g. by the finding of a deep inflation level on physical examination) is more important than exact measurement of PEEPi. If PEEPi is detected, the ventilator should be set at PEEP at 80-90% of PEEPi, low frequency (e.g. 8/min) and a long expiratory time, and high inspiratory flow.