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
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.
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Monaldi Arch Chest Dis · Apr 1995
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialThe efficacy and safety of moguisteine in comparison with codeine phosphate in patients with chronic cough.
We conducted a multicentre, double-blind, parallel group study to compare the clinical efficacy of a new antitussive drug, moguisteine (100 mg t.i.d.), to that of a reference standard, codeine (15 and 30 mg, t.i.d.). Both drugs were given orally for a period of two days. A group of 119 patients (mean age 54 yrs; 61 females and 58 males) with chronic, dry or slightly productive cough, associated with various respiratory disorders (including chronic obstructive pulmonary disease, respiratory malignancies and pulmonary fibrosis) were enrolled at six participating centres. ⋯ Adverse events were observed in two patients on moguisteine, three on codeine 15 mg, and five on codeine 30 mg. No event was serious, but discontinuation of treatment was required in two patients on codeine 30 mg. The results of our study suggest that moguisteine 100 mg t.i.d. is safe, and seems to have an antitussive activity similar to that of codeine 15-30 mg t.i.d.
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Monaldi Arch Chest Dis · Apr 1995
Comparative StudyFlow-dependent properties of positive expiratory pressure devices.
Valves for positive expiratory pressure (PEP) can be characterized as threshold resistors, ideally providing pressure independent of the expiratory flow, or as flow-dependent resistors. The aim of the study was to evaluate the flow-dependence properties of PEP devices of the flow resistor type compared to threshold resistor devices. Pressures were measured on three different flow resistor valves: the PEP-mask, the Pari-PEP-System and the System 22-PEP with orifice diameters of 1.5-5.0 mm; and on three threshold resistors, the underwater seal, the Ambu Positive End-Expiratory Pressure (PEEP) valve and the Vital Signs PEEP valve with pressures of 0, 5, 10, 15 and 20 cmH2O. ⋯ The Ambu PEEP valves acted as threshold resistors at the lower flows, but showed flow-dependency at higher flows. The Vital Signs PEEP valves gave lower pressures and Ambu PEEP valves gave higher pressures compared with indicated values, whereas the underwater seal gave the intended pressure. In clinical use of PEP treatment the actual pressure should be measured to ensure the intended pressure, no matter which type of resistor is used.
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Monaldi Arch Chest Dis · Jan 1995
ReviewPortable oxygen therapy with oxygen conserving devices and methodologies.
Oxygen therapy for the end-stage COPD patient should include a portable component. Accordingly, any system should be small and lightweight in order to enable the chronically debilitated patient to be as active and mobile as possible. Standard continuous flow oxygen via nasal cannulae is reliable and effective but it is also very wasteful. ⋯ They provide oxygen savings from 2:1 to 7:1 over continuous flow delivery. In addition to rendering the newer oxygen systems more portable, they can also reduce the cost of oxygen and its associated service. As patient requirements are highly individual, the wide choice of available methodologies permits the clinician to prescribe the system that best suits the needs of the patient.
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Completed when a person is capable, advance directives guide future health care decisions when the person has become incapable. Advance directives are based on the ethical principle of respect for auronomy, and are legally recognized in many jurisdictions. Although the advance directives currently available are generic, a disease-specific directive may be useful for people with COPD. In clinical practice, advance directives raise a number of challenging questions: With whom should the topic be raised? Should a proxy or instruction directive be used? What should be done if the patient changes his/her mind about treatment? How should people insure their advance directive is available when needed? A research for advance directives is outlined.