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 · Feb 1999
ReviewIs early noninvasive mechanical ventilation of first choice in stable restrictive patients with chronic respiratory failure?
Noninvasive long-term ventilation is consensually advocated when daytime hypercapnia > 6 kPa at steady state in chronic restrictive pulmonary syndromes. Several mechanisms can cause the occurrence of hypercapnia in these diseases. They may involve impairment of lung mechanics or airway function and cough, ventilation-perfusion mismatching, blunted central ventilatory drive or respiratory muscle fatigue. ⋯ Mechanical ventilation, usually using noninvasive methods, is offered to patients with either hypercapnia or a forced vital capacity < 20% of the predicted value. Nevertheless, based on our experience, deterioration of the restrictive syndrome should be followed by a tracheostomy. By contrast, early ventilation, offered to patients free of symptoms and whose forced vital capacity are within 20-50% pred and with normal arterial blood gas levels, achieves no benefit.
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Monaldi Arch Chest Dis · Feb 1999
ReviewLong-term oxygen therapy: advances and perspectives in technical devices.
Since the early beginnings of long-term oxygen therapy, by means of cylinders of compressed oxygen and their subsequent replacement with oxygen concentrators, most technical advances have been steadily focused on improving the facilities for continuous ambulatory oxygen therapy. Largely for this purpose, two different systems have been developed. 1) Oxygen concentrators in combination with portable cylinders for patients requiring oxygen at home and during short-term outdoor activities. If connected to an oxygen-conserving device, the duration of the ambulatory administration can be increased substantially. ⋯ A very promising product is a new kind of concentrator which can be used to refill small portable cylinders at home. This system may be a real and probably less expensive alternative to liquid oxygen. In conclusion, all future efforts should be directed at improving the facilities for providing continuous ambulatory oxygen therapy, the superior concept for pulmonary rehabilitation in patients with chronic respiratory insufficiency.
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Monaldi Arch Chest Dis · Feb 1999
ReviewMechanisms of ventilation-induced lung injury: physiological rationale to prevent it.
It is being increasingly realized that modes of mechanical ventilation that result in end-inspiratory alveolar overstretching and/or repeated alveolar collapse and re-expansion disturb the normal fluid balance across the alveolocapillary membrane. The effects of this include disturbance of the integrity of the endothelium and epithelium and impairment of the surfactant system and are similar to those seen in acute respiratory distress syndrome (ARDS). ⋯ Therefore, during mechanical ventilation, alveolar overstretching and the repeated collapse and re-expansion of alveoli should be prevented by ventilation modes that open up the lung and keep the lung open and ventilate with the smallest possible pressure amplitude. For the future, monitoring techniques should be developed that can evaluate, on-line, whether or not these therapeutic directives are being achieved.