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 · May 1995
Indications for tracheostomy and decannulation of tracheostomized ventilator users.
Ventilator users whose airway secretions can be effectively cleared do not require intubation or tracheostomy for ventilatory support, despite possibly having no measurable vital capacity and no significant ventilator-free breathing time (VFBT). Likewise, ventilator users receiving intermittent positive pressure ventilation (IPPV) via an indwelling tracheostomy can be safely decannulated and converted to the use of noninvasive ventilatory support methods provided that a minimum of 3 L.s-1 of peak cough expiratory flow (PCEF) can be achieved by unassisted coughing or by the use of manually- or mechanically-assisted coughing techniques. The use of up to 24 h.day-1 noninvasive ventilatory support is preferred by patients and caregivers over tracheostomy IPPV, and is less costly, and appears to be associated with fewer long-term complications.
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This paper describes a case of tracheobronchomegaly, which is a rare condition. The radiological, bronchoscopic and computed tomographic (CT) appearance of the condition are described. Together with the patient's history, these examinations are very useful in diagnosis, since, in cases of patients with chronic recurrent respiratory infections, they help us review any anatomical abnormalities.
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Monaldi Arch Chest Dis · May 1995
Tracheostomy and mechanical ventilation in ventilatory failure of patients with neuromuscular disease.
Decision-making about tracheostomy as a treatment of ventilatory failure in patients with neuromuscular disease is complicated by problems of several kinds (medical, surgical, psychological, ethical and social). From an experience of 90 home mechanically-ventilated neuromuscular patients (18 of whom were tracheostomized), the author reports the clinical, organizational and social aspects of the topic. ⋯ The opinion of the quality of life in tracheostomized patients with neuromuscular disease is better among the patients themselves and their relations than among other people less heavily involved. Consequently, there is a need for more direct information to the potential users of mechanical ventilation and tracheostomy, concerning the possibilities and the limitations of this method of treatment in order to offer the patients a chance to take part in the decision concerning their future life.