Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Aug 2007
Case Reports[Respiratory insufficiency in patients with progressive neuromuscular disease can sometimes be treated effectively with ventilatory support].
Three patients with myotonic dystrophy (MD) developed respiratory failure. The first was a 55-year-old man with MD who had been admitted elsewhere with pneumonia and respiratory failure. After discharge he was re-admitted with respiratory failure due to respiratory pump failure. ⋯ All three experienced a remarkable recovery of performance after the institution of mechanical ventilatory support. Respiratory failure that develops over a number of years can be easily missed in aging patients with slowly progressing neuromuscular disease. Timely recognition may lead to improved survival and quality of life by the application of non-invasive ventilatory support.
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Ned Tijdschr Geneeskd · Aug 2007
Review[Again new resuscitation guidelines (2006): justification, costs and potential confusion].
The last revision of the Dutch resuscitation guidelines, a translation of the European Resuscitation Council Guidelines 2005, is based on the recommendations of the International Liaison Committee on Resuscitation (ILCOR). The previous Dutch guidelines were issued in 2002. Most changes are based on laboratory studies and retrospective analyses. ⋯ It would be good to prospectively evaluate the effectiveness and costs of this revision. In the future, these data might help to decide when altered international recommendations should be translated into new Dutch resuscitation guidelines. Alternative strategies should be considered, for example only changing the guidelines for advanced life support.
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Ned Tijdschr Geneeskd · Aug 2007
Comment[Arguments in support of the implementation of the new guidelines for cardio-pulmonary resuscitation in the Netherlands].
The implementation of the new guidelines for cardiopulmonary resuscitation in the Netherlands has been questioned with reference to the expected low cost-effectiveness. The implementation is based on the best available evidence, derived from studies that addressed the specific activities of lay rescuers as well as professionals, but not on studies that integrate all changes in the process, from initial actions of lay rescuers to the last elements of in-hospital management. Therefore, the efficacy of new guidelines cannot be evaluated prior to wide-scale implementation. ⋯ Cost-effectiveness is not a relevant issue, as the cost of implementation of guideline changes to lay rescuers has no impact on the budget for healthcare. In addition, the revision concerns items such as the recognition of circulatory arrest, the balance of thoracic compression versus ventilation and the use of the automatic external defibrillator, which are expected to be very effective. Hence, the implementation of the new guidelines for cardio-pulmonary resuscitation in the Netherlands is justified.
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Ned Tijdschr Geneeskd · Aug 2007
Comment[The silent yet successful revolution of mechanical ventilation in patients with neuromuscular disorders, in particular Duchenne muscular dystrophy].
While developments in molecular biology have been giving rise to breakthroughs in diagnosis, management and promising treatment approaches for neuromuscular disorders, there has been a silent revolution in ventilatory support of patients with a range of neuromuscular disorders with respiratory insufficiency. In a Dutch retrospective study on ventilatory support in 48 boys with Duchenne muscular dystrophy, a 5-year survival rate of 75% was found, with 67% of the patients still living with their relatives. These data are in line with reports from Great Britain. The significant impact of ventilatory support on the natural history of various neuromuscular disorders with respiratory insufficiency is a major breakthrough.