Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Monaldi Arch Chest Dis · Jan 1993
Considerations on 200 cases of percutaneous cricothyroidotomy (minitracheotomy).
More than 10 yrs ago, minitracheotomy was suggested as an elective method in the treatment of sputum retention, resulting from impaired ability to cough, in many medical and surgical diseases. We report our experience of 200 cases of percutaneous cricothyroidotomy in our Intensive Care Unit (145 patients), and in other wards (55 patients). ⋯ About 60-70% of treated patients benefited by minitracheotomy and did not require more invasive interventions. A better control of technique, moreover, allowed other possible applications to be discovered.
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Monaldi Arch Chest Dis · Jan 1993
ReviewNon-invasive mechanical ventilation in the treatment of acute respiratory failure in chronic obstructive pulmonary disease.
Acute respiratory failure is usually managed by means of mechanical ventilation via an endotracheal tube or tracheostomy, when conservative treatment fails. Invasive mechanical ventilation is associated with several complications. The recent development of non-invasive methods of ventilation, has led to an attempt to avoid the complications of invasive mechanical ventilation during episodes of acute respiratory failure, ensuring at the same time a similar degree of efficacy. ⋯ Intermittent positive pressure ventilation by facial or nasal masks, has recently been used in the treatment of respiratory failure in place of endotracheal intubation. The results are promising, but remain controversial. It may be attempted in selected patients with obstructive respiratory disorders, but the procedure is very time-consuming for nurses.
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Monaldi Arch Chest Dis · Jan 1993
ReviewMethods and prognosis of non-invasive ventilation in neuromuscular disease.
Ventilatory failure is the commonest terminal event in many neuromuscular disorders. Increasingly, non-invasive methods of ventilation, employing both negative and positive pressure techniques, have been used, with the aim of prolonging life and reducing morbidity. The use of non-invasive ventilation is reviewed in three main groups of neurological diseases, and the degree of success assessed. ⋯ A reduction in mortality is suggested by comparison with historical controls. The institution of ventilatory support is a major undertaking for the medical team, patient and family, and should only be initiated after a full and frank discussion of the overall prognosis, in terms of both mortality and quality of life. The patient and principal caregivers can then make an informed decision as to the desirability of home ventilation.
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When single supramaximal shocks are delivered during relaxation to both phrenic nerves simultaneously, the resulting transdiaphragmatic pressure twitch (PdiT) or mouth pressure twitch (PmT) are found to decrease linearly with increasing lung volume thereby reflecting changes in diaphragm contractility. Whereas fatigue decreases PdiT at any given lung volume, chronic lung hyperinflation tends to increase PdiT at any given lung volume. ⋯ Its amplitude thus detects the reverse left for full activation of the diaphragm by the voluntary motor drive. The ability to maximally activate the diaphragm decreases with fatigue but is retained in patients with chronic lung hyperinflation.
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Monaldi Arch Chest Dis · Jan 1993
ReviewTrends in therapy of abnormal airway epithelial ion and liquid transport.
Airway epithelial ion transport, particularly that of sodium and chloride, influences the volume and composition of airway surface liquid. Defects in ion transport play an important role in the pathogenesis of some chronic airway diseases, for example cystic fibrosis. New aerosolised therapies that modulate defects in ion transport, and hence influence the natural history of cystic fibrosis are currently undergoing scrutiny. Agents such as sodium channel inhibitors and chloride channel activators are included in this class.