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 · Jun 1994
ReviewNeuroendocrine cells and airway wall remodelling in chronic airflow obstruction: a perspective.
Recent investigations suggest that airway wall remodelling and chronic airflow obstruction are almost always associated with increased pulmonary neuroendocrine (NE) cells and increased levels of bombesin-like peptides (BLPs), particularly among cigarette smokers. In contrast, most normal subjects and even smokers who do not develop airflow obstruction do not exhibit such airway wall remodelling, increased NE cells, or increased BLP levels. The hypothesis forwarded, therefore, is that NE cells and BLPs may play a role in the pathogenesis of airway wall remodelling and chronic airflow obstruction.
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Monaldi Arch Chest Dis · Jun 1994
Randomized Controlled Trial Clinical TrialVolume-controlled ventilation and pressure-controlled inverse ratio ventilation: a comparison of their effects in ARDS patients.
Volume-controlled ventilation with positive end-expiratory pressure (PEEP) (CPPV) is the conventional ventilatory approach in adult respiratory distress syndrome (ARDS) patients, but some reports suggest that pressure-controlled ventilation with an inverse inspiratory to expiratory ratio (PCIRV) may improve gas exchange in these patients. We analysed the acute effects on gas exchange, lung mechanics and haemodynamics induced by CPPV and PCIRV in ARDS patients. CPPV and PCIRV were applied randomly in ARDS patients. ⋯ Oxygen transport and total respiratory system compliance remained unchanged in both modes. Mean Paw was slightly lower during CPPV (17 +/- 1 cmH2O) than during PCIRV (19 +/- 1 cmH2O). PCIRV does not appear to have clinical advantages over CPPV in terms of gas exchange, haemodynamics, or static lung mechanics when using the same total PEEP and minute ventilation.
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Monaldi Arch Chest Dis · Jun 1994
ReviewCOPD patients and mechanical ventilation with positive end expiratory pressure (PEEP).
Application of positive and expiratory pressure (PEEP) is widely used in mechanically ventilated patients with acute respiratory failure (ARF) due to adult respiratory distress syndrome. Recent studies have suggested that application of PEEP can be useful in patients with chronic obstructive pulmonary disease (COPD) to reduce the mechanical inspiratory load due to intrinsic positive and expiratory pressure (PEEPi). In any ventilatory mode (controlled mechanical ventilation, assisted mechanical ventilation) and during weaning, application of moderate levels of PEEP replace in part PEEPi without adding to it and without significantly increasing lung volume.
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Metered-dose inhalers are the most widely-used mode of administration of bronchodilators and anti-inflammatory agents in the treatment of asthma. However, their use is complex and about 50% of the patients do not use their metered-dose inhaler(s) properly. ⋯ It is, therefore, recommended that the patient be carefully trained in the proper use of metered-dose inhalers at the time of prescription. If a patient is unable to use a metered-dose inhaler properly, despite education, it may be advisable to employ a different inhalation system.