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 · Dec 1994
Impact of heat and moisture exchangers on ventilatory pattern and respiratory mechanics in spontaneously breathing patients.
The upper airways warm and saturate inspired air with water vapour. In intubated or tracheotomized patients, this function is replaced either by hot water humidifiers or by heat and moisture exchangers (HMEs). The aim of this study was to quantify the modifications of ventilatory mechanics and patients' work when two different HMEs were added to spontaneously breathing patients. ⋯ The larger HME (Mediflux 1) increased patient's effort, with no evidence of patient discomfort. However, the smaller HME (Mediflux 2) did not add a detectable load and provided adequate humidification. In conclusion, the smaller HME appears to be preferable for the management of spontaneously breathing patients.
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Monaldi Arch Chest Dis · Dec 1994
Review Comparative StudyVentilation techniques: invasive versus noninvasive.
Conventional medical treatment of COPD patients with acute respiratory failure (ARF) was associated with an overall mortality ranging 12-29%. When conservative treatment fails, ARF is usually managed by means of mechanical ventilation (MV) via an endotracheal tube (ET) or tracheostomy. Mortality of COPD patients with ARF treated with invasive MV ranged 21-54%. ⋯ Mortality of COPD patients treated with noninvasive PPV ranged 6-25%. The level of severity of basal acidosis and blood gas response to a short trial of noninvasive PPV were predictive of success of this modality of MV. Preliminary results suggest that one year mortality after MV is reduced with noninvasive PPV in comparison to ET ventilation.
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Respiratory failure is a severe impairment of pulmonary gas exchange, consequence of lung failure leading to hypoxaemia and/or pump failure causing hypercapnia. Acute respiratory failure (acute lung injury and asthma) or acute on chronic respiratory failure (COPD and chest wall disorders) are the two terms proposed to characterize different onset and development. ⋯ Other innovative techniques are mask ventilation and proportional assist ventilation (PAV). The major aim of mask ventilation is to prevent complications related to tracheal intubation, particularly respiratory tract infections and barotrauma.
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Monaldi Arch Chest Dis · Dec 1994
Different modes of noninvasive intermittent positive pressure ventilation (IPPV) in acute exacerbations of COLD patients.
Patients with chronic obstructive lung disease may suffer from acute exacerbations of their disease, which may lead to acute respiratory failure necessitating endotracheal intubation and mechanical ventilation. We have compared retrospectively the results obtained with nasal positive pressure ventilation and those of standard medical therapy in acute relapses of severe COLD. The study showed that nasal IPPV (NIPPV) in control mode delivered for approximately 1 h, four times daily, six days a week over a 21 day period, does not result in independent improvement of acute exacerbation of COLD. ⋯ In the former study patients showing neurological signs and requiring mechanical ventilation were excluded, while in the last study patients were selected on the basis of necessity of mechanical ventilation. The fact that in the last study, ventilation was applied by face mask instead of nasal mask may have influenced results. Further efforts are required to determine whether non-invasive ventilation is more a preventive measure to avoid endotracheal intubation, or is another means of delivering ventilatory support.
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In Italy, respiratory intermediate intensive care units (IICUs) are not yet considered as autonomous hospital departments. The IICU of the Rehabilitation Department of the Medical Centre of Gussago (12 monitored beds) provides care for respiratory and cardiac patients. Ventilatory assistance and noninvasive modalities both in treatment and monitoring suggest a multidisciplinary approach to the patient. ⋯ Finally, an expert in nutrition provides an individualized dietary regimen. Our 4 year experience encourages such a multidisciplinary approach. An ideal integration of the professional activities should provide adequate and individual care for patients admitted to an IICU.