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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Ventilatory techniques are only a part of the weaning process, that also includes medical therapy, physiokinesitherapy, nutrition, psychological support and nursing. Traditional ventilatory techniques used in weaning are: T-piece trials (alternated with assist-control ventilation (ACV)), pressure support ventilation (PSV), intermittent mandatory ventilation (IMV) and continuous positive airway pressure (CPAP) ventilation. ⋯ Furthermore, NIMV by nasal or facial mask has been successfully used in the treatment of acute respiratory failure (ARF) due to various pathologies. In these cases, the weaning trial has an immediate beginning, since noninvasive ventilation is performed alternatively with spontaneous breathing after the early phase of ARF.
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Inspiratory muscles can be exerted to their maximal limits during situations of: 1) high ventilatory demands, such as in exercise; and 2) during cases of high force demands, as in obstructive or restrictive diseases. In either circumstance, the level of sustainable activity (many hours) seems to be about half of the subject's maximal ventilatory capacity (MVC) or their maximal inspiratory pressure (MIP), respectively. ⋯ When this type of patient suffers a pathology that further decreases their global respiratory muscle function or increases their load, we have the makings of an unweanable patient; the mechanical ventilator ultimately replaces the lost inspiratory muscle function. Given time for the muscle to recover force and a reduction of the loads should, thus, be the therapeutic focus.
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Monaldi Arch Chest Dis · Sep 1994
ReviewAtelectasis formation and gas exchange impairment during anaesthesia.
Anaesthesia is accompanied by impaired oxygenation of the blood, and sometimes hypoxaemia may develop despite an increased oxygen fraction of the inspired gas. The major cause of this derangement is shunt, an effect of prompt atelectasis formation in dependent lung regions. An additional cause is ventilation/perfusion (V/Q) mismatch, possibly produced by intermittent airway closure. The magnitude of shunt and size of atelectasis are independent of the age of the patient, whereas V/Q mismatch increases with age, explaining the age dependent impairment of oxygenation.
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Monaldi Arch Chest Dis · Sep 1994
Case ReportsNoninvasive mechanical ventilation in the treatment of acute respiratory failure due to infectious complications of lung transplantation.
Patients that have undergone lung and heart-lung transplantation may contract severe respiratory infections, often leading to acute respiratory failure requiring mechanical ventilation. Endotracheal intubation may induce infectious complications of the respiratory tract, which can be avoided by noninvasive modes of ventilation. We describe the use of noninvasive modes of ventilation in three cases of acute respiratory failure induced by infectious complication of lung and heart-lung transplantation. In two cases endotracheal intubation was avoided and treatment was successful.
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Monaldi Arch Chest Dis · Sep 1994
Practice Guideline GuidelineTreatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society.
1. A 6-mo regimen consisting of isoniazid, rifampin, and pyrazinamide given for 2 mo followed by isoniazid and rifampin for 4 mo is the preferred treatment for patients with fully susceptible organisms who adhere to treatment. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should be included in the initial regimen until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (i.e., there is less than 4% primary resistance to isoniazid in the community, and the patient has had no previous treatment with antituberculosis medications, is not from a country with a high prevalence of drug resistance, and has no known exposure to a drug-resistant case). ⋯ Children should be managed in essentially the same ways as adults using appropriately adjusted doses of the drugs. This document addresses specific important differences between the management of adults and children. 6. Extrapulmonary tuberculosis should be managed according to the principles and with the drug regimens outlined for pulmonary tuberculosis, except for children who have miliary tuberculosis, bone/joint tuberculosis, or tuberculous meningitis who should receive a minimum of 12 mo of therapy.(ABSTRACT TRUNCATED AT 400 WORDS)