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 · Apr 1999
Clinical TrialBronchoalveolar lavage and transbronchial lung biopsy in alveolar and/or ground-glass opacification.
In order to assess the diagnostic yield of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBB) in pulmonary diseases with a ground-glass and/or alveolar pattern on high-resolution computed tomography (HRCT) scan, a prospective study was undertaken. Thirty-six patients (17 males, 19 females), mean age 53 yrs, selected on the basis of the presence of an alveolar and/or ground-glass pattern on chest HRCT scan, were submitted to fibreoptic bronchoscopy. All patients underwent BAL. ⋯ Overall, the diagnostic yield of TBB (76%) and BAL (56%) did not differ significantly in the whole patient group (p = 0.12), or in patients with a ground-glass opacification (58 versus 36%, p = 0.3). However, in patients with areas of alveolar consolidation, the diagnostic sensitivity of TBB (95%) was significantly greater than the diagnostic sensitivity of BAL (54%) (p = 0.03). In conclusion this study shows that high-resolution computed tomography can be helpful in predicting the diagnostic accuracy of bronchological procedures, in particular of bronchoalveolar lavage and transbronchial biopsy, and that alveolar and/or ground-glass are favourable patterns for these diagnostic tools.
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Monaldi Arch Chest Dis · Apr 1999
ReviewPulmonary hypertension in acute respiratory distress syndrome.
A mild degree of pulmonary hypertension is commonly observed in patients with acute respiratory distress syndrome (ARDS). Vasoconstriction plays a dominant role in increasing the mean closing pressure of the pulmonary vascular bed. Pulmonary hypertension increases right ventricular afterload, but right ventricular failure rarely occurs in patients with ARDS. ⋯ Consequently, generalized pulmonary vasodilation by intravenous vasodilators aggravates arterial hypoxaemia. Conversely, selective administration of vasodilators, such as inhaled nitric oxide, in well-ventilated lung units improves gas exchange by diverting pulmonary blood flow to better oxygenated regions. However, preliminary results from large prospective randomized controlled trials indicate that inhaled nitric oxide does not reduce mortality nor the duration of mechanical ventilation in patients with ARDS.
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Monaldi Arch Chest Dis · Apr 1999
Comparative Study Clinical TrialThe effect of hyperoxaemia on erythropoietin secretion in anaemic patients.
Erythropoietin (EPO) controls red cell production. Hypoxaemia, reduced blood oxygen-carrying capacity and increased affinity of haemoglobin (Hb) for oxygen are the primary stimuli for EPO secretion. The effect of hyperoxaemia (arterial oxygen tension (Pa,O2) > 13.3 kPa) on EPO secretion has not been thoroughly studied and is not fully understood. ⋯ During normoxaemia, EPO levels increased again in group I patients, but in group II patients EPO production remained stable. In conclusion, hyperoxaemia inhibits erythropoietin secretion in spite of anaemia and low arterial oxygen tension. Hyperoxaemia may be a contributing factor to anaemia in intensive care unit patients under oxygen therapy.
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This paper reviews respiratory muscle performance in patients suffering from congestive heart failure. Respiratory muscle dysfunction is well documented in these patients, and is thoroughly discussed. The mechanisms underlying its development and the potential consequences are also presented.
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Monaldi Arch Chest Dis · Apr 1999
Noninvasive positive pressure ventilation in trauma patients with acute respiratory failure.
The effectiveness of noninvasive pressure support ventilation (NIPSV) in treating trauma patients with acute respiratory failure (ARF) was evaluated in a retrospective clinical study. Forty-six conscious patients with ARF admitted to the general intensive care units (ICUs) of three hospitals between July 1988 and July 1991 were surveyed. Patients received NIPSV after a period of spontaneous breathing with supplemental oxygen. ⋯ In the 22 patients who were hypercapnic at the point of entering the study, the arterial carbon dioxide tension (Pa,CO2) decreased from 73.0 +/- 1.0 kPa (52.5 +/- 7.8 mmHg) (spontaneous breathing) to 5.5 +/- 1.0 kPa (41.5 +/- 7.5 mmHg) (NIPSV) (p < 0.01) and pH increased from 7.29 +/- 0.05 to 7.33 +/- 0.04 (p < 0.05). The median length of time of use of NIPSV was 55.5 h (range 6-144). In conclusion, noninvasive pressure support ventilation might effectively be used in a selected group of trauma patients as a means of treating respiratory failure.