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 · Dec 1995
Review Comparative StudyEmpirical antibiotic therapy and lower respiratory tract infections: European guidelines and current practices.
Guidelines for the management of lower respiratory tract infection have been published in four European countries. The scope of each of these articles is reviewed and the similarities, differences and deficiencies highlighted. Very little is known about how lower respiratory tract infections (LRTIs) are managed in routine practice in Europe, especially in the community. The available data suggest major differences in antibiotic use between countries which is likely to be multifactorial in origin.
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Monaldi Arch Chest Dis · Oct 1995
ReviewRole of surfactant in the pathophysiology of the acute respiratory distress syndrome (ARDS).
Acute respiratory distress syndrome (ARDS) has become a well-recognized condition that can result from a number of different causes that lead to injury of the alveolar-capillary membrane. This results in high-permeability pulmonary oedema that disturbs the pulmonary surfactant system. In ARDS, the treatments available are still inadequate and morbidity, mortality, and costs remain unacceptably high. ⋯ It has been suggested that the increased permeability changes, along with the inflammatory response, lead to accumulation of plasma components in the alveolar space, causing inhibition of the instilled surfactant in a dose-dependent way. Thus, for treatment of ARDS, a high concentration of surfactant is required to overcome the inhibitory effect of plasma components. However, a few questions remain unanswered, including: When should surfactant treatment start? Which dosage? Of which type of surfactant? Which method of administration should be used, in combination with which type of ventilatory support, etc.?
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Monaldi Arch Chest Dis · Aug 1995
Randomized Controlled Trial Comparative Study Clinical TrialClinical evaluation of oscillating positive expiratory pressure for enhancing expectoration in diseases other than cystic fibrosis.
The benefit of chest physiotherapy in patients with cystic fibrosis has been well documented. However, the benefit of similar rehabilitation in patients with large amounts of sputum who have diagnoses other than cystic fibrosis has not been clearly demonstrated. The aim of this study was to evaluate the acute effectiveness of a device advised for home chest physiotherapy in comparison to postural drainage combined with chest percussion in removing secretions in patients with high sputum production due to diseases other than cystic fibrosis. ⋯ The mean time that the patients tolerated treatment was not different for A and B (18.7 +/- 5 and 19.3 +/- 5 min, respectively). Sputum significantly increased during both treatment periods and in the same amount for the two modalities (2.9 +/- 2.9 to 10.9 +/- 7.1 and 2.8 +/- 3.1 to 10.1 +/- 10.8 mL for A and B, respectively). Visual analogue scale score significantly decreased at the end of each treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.