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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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.
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Inspiratory muscles can be exerted to their maximal limits during situations of: 1) high ventilatory demands, such as in exercise; and 2) during cases of high force demands, as in obstructive or restrictive diseases. In either circumstance, the level of sustainable activity (many hours) seems to be about half of the subject's maximal ventilatory capacity (MVC) or their maximal inspiratory pressure (MIP), respectively. ⋯ When this type of patient suffers a pathology that further decreases their global respiratory muscle function or increases their load, we have the makings of an unweanable patient; the mechanical ventilator ultimately replaces the lost inspiratory muscle function. Given time for the muscle to recover force and a reduction of the loads should, thus, be the therapeutic focus.