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 · Oct 2002
ReviewNon invasive mechanical ventilation in cystic fibrosis: physiological effects and monitoring.
Chronic respiratory insufficiency in cystic fibrosis (CF) is characterised by an increase in respiratory load, which leads to alveolar hypoventilation with the preservation of respiratory muscle strength. Non-invasive mechanical ventilation (NIMV) is able to improve alveolar ventilation and thus gas exchange and allow the the respiratory muscles to rest in patients with cystic fibrosis with variable severity of lung disease. ⋯ After a successful evaluation, the monitoring of patients starting NIMV can be performed with simple, non invasive parameters such as gas exchange, tidal volume, respiratory rate, minute ventilation and comfort. In the long term however, studies are warranted to assess the benefit of NIMV in terms of lung function, quality of sleep and most importantly, quality of life.
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Sleep has well recognised effects on respiratory muscle function, most of which are detrimental. Upper airway dilator muscle function is compromised, which predisposes to obstruction, particularly during rapid-eye-movement sleep (REM). ⋯ However, accessory muscle function is reduced, particularly during REM sleep, which may have adverse effects on lung mechanics. These changes contribute to hypoventilation and worsening ventilation-perfusion mismatching, particularly in patients with chronic lung disease such as COPD, with resulting oxygen desaturation.
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Monaldi Arch Chest Dis · Oct 2002
ReviewNocturnal ventilation in neuromuscular disease--when and how?
While much evidence has been gained over the last decade to support the use of non-invasive ventilation (NIV) in a series of acute and chronic applications, some issues still need to be addressed, particularly regarding the timing of initiation of NIV and the best methods of implementation. This article discusses the role of NIV, if any, in preventing respiratory decline, as a physiotherapy adjunct, and in perioperative care for adults and children with neuromuscular disease.
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Monaldi Arch Chest Dis · Oct 2002
GENEBU Project. Equipment and drugs used for home nebulizer therapy in Italy.
The GENEBU Project is an open, observational survey evaluating home nebulizer practices in Italy. It consecutively included patients who were referred to one of the 27 participating chest clinics from May to December 1999 and who had been using a home nebulizer in the previous six months. The information source was a self-administered questionnaire compiled by the enrolled subjects. ⋯ More than 90% of patients mixed some active drugs. We conclude that the nebulizer equipment for home aerosol therapy was very heterogeneous and, probably, not always utilised at its best in Italy. The mixing of drugs and the widespread use of corticosteroids were peculiarities of home nebulizer therapy in Italy.